Health Care

Prescription Drug 

Benefits 

You can buy prescription drugs at a low cost through any pharmacy 

that participates in the CVS/Caremark network or through a 

convenient mail-order program. The medical deductible and copay 

provisions do not apply to the prescription drug benefits. 

Your Prescription Drug Benefits at-a-Glance 

Prescription Drug Benefits 

Retail prescription 

drugs purchased 

through a network 

pharmacy (34-day 

supply) 

• $5 copay for generic drugs. 

• $18 copay for preferred drugs. 

• $33 copay for brand-name and non-preferred drugs. 

Mail-order 

prescription drugs 

(90-day supply)

• $10 copay for generic drugs. 

• $36 copay for preferred drugs. 

• $66 copay for brand-name and non-preferred drugs. 

Prescription drugs 

purchased at a 

nonparticipating 

pharmacy 

No coverage.

Prescription Drug Benefits and the Medical Plan 

The prescription drug benefit is separate from your medical benefit. So 

prescription drug copays do not apply to the medical plan deductible and out-ofpocket maximum. Nor do the medical benefit deductible and copay provisions

apply to the prescription drug benefit. 

Using Your Prescription Drug Benefits 

Retail Pharmacies 

Important Note!

Always ask your pharmacy

if it is a member of the 

CVS/Caremark network 

before filling a prescription. 

Prescriptions purchased at 

a nonparticipating 

pharmacy are not covered 

under this plan. 

The plan contracts with CVS/Caremark to fill prescriptions for you and your 

covered dependents. Before filling a prescription, ask the pharmacy if it is a 

member of the CVS/Caremark network. Prescriptions purchased at a 

nonparticipating pharmacy are not covered under this plan. 

You must present your prescription drug identification card to receive benefits for 

drugs bought at a pharmacy. For your covered dependents’ prescriptions, you will

also need to provide a date of birth. 

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Health Care

When you purchase up to a 34-day supply of prescribed drugs and medications, 

the plan pays 100% after you pay a: 

• $5 copay for generic drugs 

• $18 copay for preferred drugs 

• $33 copay for brand-name and non-preferred drugs 

If you do not present your prescription drug identification card, you will be 

reimbursed for a drug, provided you: 

• Pay the full price of the prescription at the time of purchase, 

• Have your pharmacist fill out a claim form, and 

• Submit the claim form to the prescription drug claims administrator for 

reimbursement. 

However, your reimbursement may be less than if you had presented your card at

the time of service. You will pay the copay and any amounts above the network 

pharmacy discount to the pharmacy. 

Mail-Order Prescriptions 

If you take prescribed drugs on a long-term or continuing basis, you can obtain 

them by mail. When you purchase up to a 90-day supply of mail-order prescribed

drugs and medications, the plan pays 100% after you pay a: 

• $10 copay for generic drugs 

• $36 copay for preferred drugs 

• $66 copay for brand-name and non-preferred drugs 

Your prescription will automatically be filled with a generic drug, unless your 

doctor has indicated otherwise on your prescription. New prescriptions generally 

take two to three days to process and fill. Refills take one to two days to process 

and fill. Shipping is free of charge, and takes 10-14 days for standard delivery. 

You can choose two-day or next-day shipping; however, it will still take one to 

three days for your order to be processed before it is shipped. If delivery is 

delayed for any reason, your order will not be reprocessed until 15 days from the 

original shipping date. 

For further information, order forms and pre-addressed envelopes, contact 

CVS/Caremark at the number listed in the Contact Information section. 

Covered Expenses 

Covered drugs include: 

• Prescribed drugs that are lawfully obtainable only from a licensed dispenser 

of drugs under the written order of a physician or dentist licensed to prescribe 

• Injectable insulin 

• Prescribed syringes and hypodermic needles in quantities compatible with 

the number of doses of insulin prescribed (Note: You must fill the insulin 

order first for the syringes to be covered by the plan.) 

Call CVS/Caremark at the number listed in the Contact Information section to

determine whether or not a new drug is covered. 

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Health Care

Expenses Not Covered 

The following are not covered under the plan: 

• Contraceptive devices, regardless of the purpose for which they are 

prescribed (Oral contraceptives are covered, but skin implant contraceptives

such as Norplant are not.) 

• Fertility drugs 

• Drugs or medications lawfully obtainable without a prescription, except insulin 

• Therapeutic devices and appliances, support garments or other nonmedical 

items, regardless of their intended use 

• Drugs labeled “Caution: Limited by federal law to investigational use” or 

experimental drugs, even though a charge is made to the individual

• Charges for the administration of prescription drugs or injectable insulin 

• Drugs taken by or administered to an individual in whole or in part while an

inpatient in a hospital or other health care facility licensed for dispensing

pharmaceuticals 

• A quantity in excess of the number specified by the prescriber for a 34-day 

supply (90-day for mail-order) 

• Any refill dispensed more than one year after the date of the prescription 

• Prescription drugs that may be properly received without charge under local, 

state or federal programs, including Workers’ Compensation

• Renova (Tretinoin) 

• Lifestyle drugs such as drugs treating weight loss (except in the case of 

morbid obesity) and hair loss. Drugs prescribed for erectile dysfunction (ED) 

in excess of six doses per month 

• Prescriptions purchased at a nonparticipating pharmacy 

• Expenses for drugs obtained through another medical or prescription drug 

plan (no coordination of benefits) 

• Claims filed more than one year after the date the expense was incurred 

Filing a Claim 

If you do not have your prescription drug card when you make a retail purchase, 

you must pay for the prescription when purchased and have the pharmacist fill 

out a CVS/Caremark claim form. You must then submit your claim to: 

Filing Deadline

If you do not file a claim 

within 365 days of the date 

you incur an expense, 

reimbursement will be 

denied. 

CVS/Caremark

P.O. Box 52116 

Phoenix, AZ 85072 

For more information about appealing claims and additional claims review 

procedures, see “Claims Review and Appeals Procedures” in the Rules,

Regulations and Administrative Information section. For additional contact 

information for claims administrators, see the Contact Information section.

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Health Care

Dental Benefits 

The BlueCare® Freedom Dental PPO program allows you and/or 

your eligible dependent(s) the freedom to choose any licensed 

dentist when you need dental care. You will maximize your dental 

benefits when you access a contracting general or specialty dentist 

through the BlueCare® Dental PPO Network. Advantages of using 

the BlueCare Dental PPO Network are: 

• Reduced out-of-pocket costs due to discounted fees 

• No balance billing 

• No referral needed for specialty dentists 

• Contracting dentists will submit claims for you 

Your dental benefits remain the same whether you select a dentist from within

or outside the network; services are covered at the same benefit level. However, 

if you choose to receive services from a dentist outside of the network, the plan

will pay a percentage of the charges for covered services, based on usual and 

customary (U&C) charges, up to a maximum annual or lifetime benefit, depending 

on the services received. 

When your dependent needs orthodontic care, treatment must begin before 

age 16. 

Your Dental Benefits at a Glance 

Dental Benefits In-Network Out-of-Network 

Maximum annual 

benefit 

$2,000 per covered family 

member (excluding 

orthodontic). 

$2,000 per covered family 

member (excluding 

orthodontic). 

Annual calendar 

year deductible 

No deductible applies. No deductible applies. 

Preventive care 

(two oral 

exams/year) 

Plan pays 100% of PPO 

negotiated rates. 

Plan pays 100% of U&C 

charges.

All nonorthodontic 

dental care 

Plan pays 80% of eligible 

expenses, based on the 

PPO negotiated rate, up 

to the maximum annual 

benefit. 

Plan pays 80% of eligible 

expenses, based on the 

U&C amount, up to the 

maximum annual benefit. 

Orthodontic

dental care 

Plan pays 80% of U&C, 

up to a lifetime maximum 

of $2,000, for each eligible 

covered dependent. 

Plan pays 80% of U&C, 

up to a lifetime maximum 

of $2,000, for each eligible 

covered dependent. 

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Health Care

Using Your Dental Benefits 

Dental benefits provide comprehensive coverage for preventive and other types 

of dental services, including orthodontia. When you need dental care, you must 

visit a licensed dentist. 

In-network dental benefits are available when you choose a provider that 

participates in the Blue Cross/Blue Shield (BCBS) BlueCare® Freedom Dental 

PPO Program. The benefit remains the same whether you use an in-network or

out-of-network provider. However, in-network providers have agreed to accept a 

negotiated rate for their services. 

If you choose a nonparticipating provider, you can be billed for any amount over

what is paid by BCBS. 

Benefit Amounts 

Preventive care: Preventive care is covered at 100% of the PPO negotiated rate

for in-network dentists or U&C charges for out-of-network dentists. Preventive 

services include two oral exams a year, including teeth cleaning, fluoride 

applications (up to 19 years of age) and dental x-rays (two bitewings per year and 

one full mouth x-ray every 36 months). 

Other care: The plan pays 80% of the PPO negotiated rate for other covered 

dental care provided by in-network dentists (80% of U&C charges for out-ofnetwork dentists). 

Annual maximum (excluding orthodontic): The maximum amount the plan will 

pay each calendar year is $2,000 per person. When you or your covered 

dependents reach this limit, you are responsible for the full cost of any additional

services received. 

How the Orthodontic Benefit Works 

When your covered dependent needs orthodontic care, he or she must visit a 

licensed orthodontist or dentist. The plan pays a percentage of the charges for 

covered services, up to a maximum annual benefit. You pay no deductible. 

Orthodontic treatment must begin before age 16 and may continue beyond 

age 19 (when the dependent would otherwise lose eligibility), provided your 

covered dependent remains: 

• A full-time student, 

• Unmarried, 

• Financially dependent on you, and 

• A resident in your household. 

Benefit Amount 

The plan pays 80% of the first $2,500 of expenses for each covered dependent 

under age 19. That’s a lifetime maximum orthodontia benefit of $2,000 per 

covered dependent. 

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Health Care

Cost

Generally, an orthodontist establishes the total cost of his or her services, 

supplies and appliances before treatment starts. This is paid by an initial down 

payment with regular monthly payments thereafter. You are responsible for the 

initial down payment. You will be reimbursed for the down payment (but not more 

than 16% of the entire treatment — 80% of 20%), and the plan will make regular 

monthly payments of the benefit for the remaining costs. The plan’s payments for 

orthodontic services will end when you meet the lifetime maximum benefit or 

coverage under the plan ends. 

To receive your monthly reimbursements, you must: 

• Continue to qualify as a plan participant, and 

• Submit paid receipts from your orthodontist for your monthly payment. 

You cannot receive your total reimbursements in less than 24 months unless your 

dentist certifies that the orthodontic correction is completed. 

Covered Dental Expenses 

Your dental benefits provide coverage at PPO negotiated rates or U&C charges 

for the following types of services: 

• Two oral exams, including teeth cleaning and scaling, every calendar year; 

additional cleanings (up to four per year) to treat periodontal disease with a 

letter of medical necessity 

• Fluoride applications up to age 19 

• Application of dental sealant up to age 19

• Dental x-rays (bitewings limited to two per year; full mouth limited to once 

every 36 months) 

• Extractions and oral surgery 

• Fillings and inlays 

• Crowns and initial installation of fixed bridgework 

• Artificial tooth implants 

• Treatment of diseases of the gums and tissue of the mouth 

• Initial installation of removable partial or full dentures 

• The addition of teeth to an existing removable partial or full denture or fixed 

bridgework, or its total replacement, if made necessary by drifting of anchor 

teeth 

• Repair or recementing of crowns, inlays, bridgework or dentures

• Treatment for tooth damage that results from the grinding or biting of teeth 

(occlusal services) 

• General anesthesia for dental procedures when medically necessary 

• Orthodontia 

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Health Care

Expenses Not Covered 

Dental benefits do not cover: 

• Expenses to treat a participant’s illness or injury arising from any electrical 

work or any other paid work; expenses for a dependent paid or payable 

under any Workers’ Compensation law (whether performed for pay or not) or 

any other paid work 

• Treatment by someone other than a licensed dentist or physician (the plan 

will cover teeth cleaning by a licensed dental hygienist who is supervised by 

a dentist) 

• Any work performed directly by a lab and billed to you without a prescription

from a dentist, such as manufacture or repair of dentures, liners and other 

devices and appliances; services and supplies of any kind furnished directly 

by a lab 

• Replacement of a lost or stolen prosthetic device 

• Services and supplies that are solely for cosmetic reasons, such as bonding

or whitening 

• Services that are not medically necessary 

• Treatment in a hospital operated by the federal government or a federal 

agency for a disability connected to military service 

• Illness or injury resulting from any act of war or international armed conflict, 

participation in a riot or the commission of a criminal act 

• Treatment for which there would be no charge if these benefits were not 

available 

• Services provided by a relative or a person who ordinarily resides with you 

• Services provided or paid through any other plan

• Treatment of any intentionally self-inflicted injury (except in cases of mental 

illness) 

• Broken appointments 

• Claims filed more than one year after the date the expense was incurred 

Orthodontic Expenses Not Covered 

• Expenses for participants other than eligible covered dependents 

• Expenses for a dependent paid or payable under any Workers’ 

Compensation law (whether performed for pay or not) or any other paid work 

• Treatment by anyone who is not a licensed orthodontist or dentist 

• Replacement of lost or stolen retainers 

• Services or supplies furnished on or after the date your dependent turns 

age 16, unless those procedures began before age 16

• Services and supplies that are solely for cosmetic reasons 

• Treatment for which there would be no charge if these benefits were not 

available 

• Services provided by a relative or a person who ordinarily resides with you 

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Health Care

• Services provided without charge or paid through any other plan

• Broken appointments 

• Claims filed more than one year after the date the expense was incurred 

Filing a Claim 

In-network providers will file a claim for you. Out-of-network providers will usually

file a claim for you; but if you are required to file a dental claim, call BCBS at 

1-800-862-3386 to obtain a dental claim form. All dental claims should be 

submitted to:

Filing Deadline

If you do not file a claim 

within 365 days of the date 

you incur an expense, 

reimbursement will be 

denied. 

Blue Cross/Blue Shield of Illinois 

c/o DNoA 

P.O. Box 23059 

Belleville, IL 62223 

When you submit your Request for Benefit Payment form, it should be completed 

fully, following the instructions printed on the form. Failure to do so may delay 

payment or result in denial of benefits. Attach a statement from your physician or 

dentist together with bills or receipts for all covered expenses, including those 

that count toward the deductible. To make sure you receive all the benefits you 

are entitled to, you should keep copies of bills or receipts for supplies, as well as

those for hospitalization and treatment. If all charges are not detailed on the 

request form, attach an itemized statement. 

For more information about appealing claims and additional claims review 

procedures, see “Claims Review and Appeals Procedures” in the Rules,

Regulations and Administrative Information section. For additional contact 

information for claims administrators, see the Contact Information section.

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Health Care

Vision Benefits 

In-network vision benefits are provided by VSP (Vision Service 

Plan). However, you can visit any out-of network licensed optician,

optometrist or ophthalmologist and receive a lesser out-of-network 

benefit. 

Important Note!

Before you make an 

appointment, notify the 

provider that you are 

covered under VSP. 

Your Vision Benefits at a Glance 

Vision Benefits 

In-Network Out-of-Network

Annual calendar year 

deductible 

No deductible applies. 

Annual calendar year 

benefit maximum 

Not applicable. 

Exam After a $20 copay per 

exam, plan pays 100% 

on up to one exam per 

year. 

After a $20 copay per 

exam, plan reimburses up 

to $45 on one exam per 

year. 

Lenses (includes 

glasses and frames) 

After $20 copay per pair, 

plan pays100% (frame 

costs in excess of $125 

are your responsibility, 

but discounted by 20%). 

After a $20 copay per pair,

plan reimburses up to 

specified limits depending 

on the type of lens and 

frame. 

Contact lenses Participant: Plan pays 

100% of discounted 

prices up to $200 per 

pair per year.

Dependent: Plan pays 

100% of discounted 

prices up to $200 per 

year. 

Participant: Plan 

reimburses up to $200 per 

pair per year.

Dependent: Plan 

reimburses up to $200 per 

year. 

Participant annual 

limits 

Two sets of framed lenses or two sets of contact lenses 

or one of each. 

Dependent annual 

limits 

One set of framed lenses or one set of contact lenses. 

Using Your Vision Benefits 

You must visit a licensed optician, optometrist or ophthalmologist. You may 

choose to visit either in-network or out-of-network providers, but with in-network 

providers the cost savings can be substantial. For in-network services, the plan 

pays the cost of covered services after you pay a copay. For out-of-network 

services, you pay a copay, then you will be reimbursed for part of the expense of

eye exams, frames and lenses. You pay no deductible.

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Health Care

You must submit claim forms within six months for non-VSP providers. When you 

submit claim forms, you must include receipts. 

VSP Network Advantages 

You and your covered dependents benefit when you use providers who 

participate in the VSP network (network providers) because: 

• Network providers have agreed to accept pre-negotiated, discounted rates for 

their services. Since network providers charge discounted rates, you (and the 

Fund) save money when you use them. 

• Network providers will file claims for you. When you go to a network provider, 

all you have to do is pay your $20 copay(s) (and any amount that exceeds 

specific maximums) and your provider will file a claim with VSP for 

reimbursement. There are no copays for contact lenses. 

• You receive discounted prices on all your vision care needs, including those 

that are not covered by your plan, such as extra supplies and laser vision 

correction services. 

• When you go to a non-network provider, you must pay for the services at the 

time you receive them and then file a claim with VSP. After any applicable 

copays, the plan will then reimburse you up to the scheduled amount. This 

amount will not be sufficient to pay for the entire cost of the eye examination 

or materials and you will not receive discounted prices. 

Finding VSP Network Providers 

VSP’s network includes many providers; so your current provider may already be 

in the VSP network. To locate a VSP network provider, you can: 

• Ask your provider if he/she participates in the VSP network

• Call VSP Member Services at 1-800-877-7195, Monday-Friday, 8:00 a.m. 

until 8:00 p.m. 

• Visit their Web site at www.vsp.com for more information 

Covered Expenses 

The plan pays benefits for the following medically necessary expenses in a 

calendar year: 

• Complete vision analysis, including eye exam, refraction, visual therapy and 

case history

• Two sets of framed lenses or two sets of contact lenses (or one set of each)

for a participant if required by a prescription. One set of framed lenses or 

contact lenses for a dependent if required by a prescription. 

Expenses Not Covered 

The plan does not cover: 

• Expenses to treat a participant’s illness or injury arising from any electrical 

work or any other paid work. Expenses for a dependent paid or payable 

under any Workers’ Compensation law (whether performed for pay or not) or 

any other paid work 

• Replacement of lost or stolen glasses, or broken frames 

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Health Care

• Services in connection with vision therapy, orthoptics, vision training, 

aniseikonia, or medical or surgical treatment of the eye unless performed by 

a licensed medical physician or licensed therapist 

• Any surgical treatment in place of corrective lenses such as LASIK, 

photorefractive keratectomy (PKR) or radial keratotomy (RK) 

• Treatment in a hospital operated by the federal government or a federal 

agency for a disability connected with military service 

• Charges for services or supplies covered in whole or in part under any other 

portion of this benefit plan 

• Illness or injury resulting from any act of war or international armed conflict, 

participation in a riot or the commission of a criminal act 

• Treatment for which there would be no charge if these benefits were not 

available 

• Services provided by a relative or a person who ordinarily resides with you 

• Services or supplies provided without charge or paid through any other plan

• Expenses that are reimbursable by Medicare 

• Treatment of any intentionally self-inflicted injury (except in cases of mental 

illness) 

• Broken appointments 

• Claims filed more than one year after the date the expense was incurred 

Filing a Claim 

No claim forms are required when you use a VSP participating provider. All 

claims are filed directly with VSP by the provider. Important Note!

If you see a non-VSP 

provider, you must file 

your claim(s), and the filing

limit is six months from 

date of service.

To submit a nonparticipating provider claim, you must contact VSP at 

1-800-877-7195 to obtain a claim form. The reimbursement rate is significantly 

less than it would be if you used a VSP provider. 

For more information about appealing claims and additional claims review 

procedures, see “Claims Review and Appeals Procedures” in the Rules,

Regulations and Administrative Information section. For additional contact 

information for claims administrators, see the Contact Information section.

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Health Care

Continuing Coverage 

A federal law, the Consolidated Omnibus Budget Reconciliation Act 

(COBRA) of 1985, requires that participants and their covered 

dependents be able to continue certain health care coverage when 

they would otherwise lose coverage. Coverage continues at your 

own expense. 

Under COBRA, you and your covered dependents (or former dependents) have 

the right to continue medical, prescription drug, dental, orthodontic, vision and 

hearing aid coverage. Or you may elect to continue medical and prescription drug

coverage only. You receive the same benefits as active employees for the option 

you choose. COBRA does not extend to other benefits under this plan, such as

short-term disability, long-term disability, dismemberment or life insurance. 

COBRA coverage for you and your covered dependents continues for up to 18 

months if you become eligible for COBRA because your hours are reduced below 

the number required for coverage or your employment is terminated.

COBRA coverage is also available to your covered dependents for up to 36 

months if their coverage ends because: 

• You die, 

• A covered child becomes ineligible due to age, 

• You get a divorce or legal separation, or 

• You become entitled to Medicare. 

If you retire at age 60 and meet the qualifications for retiree health care, you are 

eligible for COBRA coverage for 18 months. You can request interim coverage 

which extends your coverage for up to six months; you pay the full cost of the 

coverage. This interim coverage will take you to age 62, at which time you would 

be eligible for retiree coverage. You must contact the Fund Office in writing to 

request interim coverage. 

You or a family member is responsible for notifying the Trustees of any event that 

makes continuation of coverage applicable. Such events include divorce, death, 

or becoming Medicare-entitled because of disability or a dependent becoming 

ineligible because of age. 

Who Is Eligible for COBRA Coverage 

You and your eligible dependents are eligible for COBRA. 

Newborns and children adopted by you while you are covered under COBRA are 

eligible to elect COBRA coverage immediately. Your new child is a “qualified 

beneficiary” with independent election and second qualifying event rights. 

If you have any questions about your eligibility for COBRA, or you do not receive 

coverage information within 14 days of notification of a qualifying event, contact 

the Fund Office. 

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Health Care

How to Enroll for COBRA Coverage 

EIT’s COBRA coverage is administered by EIT Benefit Funds. You will receive an

election form from the Fund Office and more information about COBRA coverage 

if you become eligible for it. In the case of a divorce or ineligibility of a dependent

child, the qualified beneficiary must notify the Fund Office to receive an election 

form. 

To continue coverage, you or your affected dependent must elect COBRA 

coverage within 60 days after an event qualifies you for COBRA or after the Fund

Office mails your election form, whichever is later. Your spouse and dependent 

children have separate election rights. You have an additional 45 days from the 

date you return your election form to pay the premiums necessary to avoid any 

gap in coverage. Any claims you file are not paid until the plan receives your 

contribution. 

If coverage is modified for active employees, COBRA coverage will also be

modified. If you do not elect COBRA coverage within the 60 days described 

above, coverage will end and will not be reinstated. 

You, your spouse and dependent children who lose coverage as a result of the 

COBRA qualifying event are qualified beneficiaries entitled to elect COBRA. A 

child born to, adopted by or placed for adoption with you during the period of 

COBRA coverage would also be a qualified beneficiary with a right to COBRA 

coverage. Each qualified beneficiary has an independent right to elect COBRA 

coverage. You may elect COBRA coverage on behalf of your spouse, and 

parents may elect COBRA coverage on behalf of their children. 

In deciding to elect COBRA coverage, you should know that a failure to continue

your group health coverage will affect your future rights under federal law as 

follows: 

• You can lose the right to avoid having pre-existing condition exclusions 

applied to you by other group health plans if you have more than a 63-day 

gap in health coverage. Election of COBRA coverage may help you not have 

such a gap. 

• You will lose the guaranteed right to purchase individual health insurance 

policies that do not impose such pre-existing condition exclusions if you do 

not elect and maintain COBRA coverage for the maximum time available to 

you. 

• You should take into account that you have special enrollment rights under 

federal law. You have the right to request special enrollment in another group 

health plan for which you are otherwise eligible (such as a plan sponsored by 

your spouse’s employer) within 30 days after your group health coverage

ends because of the qualifying event listed above. You will also have the 

same special enrollment right at the end of COBRA coverage if you elect and 

maintain COBRA coverage for the maximum time available to you. 

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Health Care

How Much COBRA Coverage Costs 

You pay 102% of the regular contribution rate or the cost of coverage for 

participants and dependents (100% of the premium plus a 2% administration fee). 

The Trade Act of 2002 created a new tax credit for certain individuals who 

become eligible for trade adjustment assistance and for certain retired individuals 

who are receiving pension payments from the Pension Benefit Guaranty 

Corporation (PBGC) (eligible individuals). Under the new tax provisions, eligible 

individuals can either take a tax credit or get advance payment of 65% of 

premiums paid for qualified health insurance, including COBRA continuation 

coverage. If you have questions about these new tax provisions, you may call the 

Health Coverage Tax Credit Customer Contact Center toll-free at 

1-866-628-4282. TTD I TTY callers may call toll-free at 1-866-626-4282. More 

information about the Trade Act is also available at www.doleta.gov/tradeact/. 

How Long COBRA Coverage Lasts 

COBRA coverage can continue up to 18, 29 or 36 months depending on the 

qualifying event. If more than one qualifying event applies, the maximum 

coverage period is 36 months total. The following chart shows when you and your 

dependents may continue health care coverage under COBRA and for how long. 

COBRA Qualifying 

Event 

Maximum Period Coverage Can Continue 

COBRA Qualifying 

Event 

You Spouse Child

You lose coverage

because: 

• Your hours are 

reduced 

• Your employment 

ends for any reason 

(except gross 

misconduct)

18 months 18 months 18 months

You or your qualified 

dependent are disabled 

(as defined by Social 

Security) when you lose 

coverage 

29 months 29 months 29 months

You die N/A 36 months 36 months

You and your spouse 

divorce or become legally 

separated 

N/A 36 months 36 months

You become entitled to 

Medicare* 

N/A 36 months 36 months

Your child no longer 

qualifies as an eligible 

dependent 

N/A N/A 36 months

* If you become entitled to Medicare before your coverage ends, your spouse and any dependent 

children are entitled to elect COBRA coverage for up to the greater of 36 months from the date of 

Medicare entitlement, or 18 months from the date your coverage ends. 

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Health Care

Additional Qualifying Events 

The 18-month COBRA period may be extended to 36 months for your spouse 

and dependent children who are qualified beneficiaries if a second qualifying 

event (death, divorce, legal separation or a dependent child ceasing to be a 

dependent under the terms of the plan) occurs during the 18-month COBRA 

continuation period. However, this extension will only be allowed if the second 

event would have caused the spouse or dependent child to lose coverage under 

the plan had the first qualifying event not occurred. To be granted an extension,

the qualified beneficiary must notify the Fund Office within 60 days of the second 

qualifying event. 

Please note: Your Medicare entitlement (Part A, Part B or both) is considered a 

second qualifying event for your spouse and dependent children under the EIT 

plan. 

Disability Extension 

The 18-month COBRA continuation period may be extended by up to 11 months

for a total of 29 months if a qualified beneficiary is determined by Social Security 

to be disabled at any time within 60 days of the start of the COBRA continuation 

period. This 11-month extension is available to all individuals who were qualified 

beneficiaries at the time of the initial termination or reduction in hours of 

employment. To be granted this extension, you must notify the Fund Office at 

1-312-782-5442 within 60 days of the determination and within the 18-month 

COBRA continuation period. You must also provide a copy of the determination

of disability notification from the Social Security Administration. 

The disabled individual must also notify the Fund Office within 30 days of any 

final determination that such individual is no longer disabled. 

When COBRA Coverage Ends

COBRA health care coverage will end before the maximum period described in 

the “Maximum Period Coverage Can Continue” chart in this “Continuing 

Coverage” section, if: 

• Required premiums are not paid by the due date. 

• You, your spouse or dependent becomes covered under another group 

health plan, including a Medicare plan, after you have made your COBRA 

election (this does not apply if the new plan has pre-existing condition limits 

affecting the covered person). 

• You, your spouse or dependent become eligible for Medicare (this only 

affects the person with Medicare coverage). 

• You, your spouse or dependent recover from disability during the 11-month 

extension period. 

• EIT no longer provides health care coverage to any of its active employees. 

COBRA coverage may also be terminated for any reason the plan would 

terminate coverage of a participant or beneficiary not receiving COBRA coverage

(such as fraud).

If your COBRA coverage terminates for any reason, it cannot be reinstated. 

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Health Care

Notice and Election Procedures 

To protect your family’s rights, you should keep the appropriate parties informed

of any changes in address, as follows: 

• Participant address: If your address changes, you should notify the Fund 

Office. 

• Dependent address: Also notify the Fund Office if your spouse or 

dependent(s) changes address (to an address other than your address). 

If you have any questions or need to provide notice or make an election related to 

your COBRA rights, contact the Fund Office at 1-312-782-5442 Monday through 

Friday between 8:30 a.m. and 4:30 p.m. Central Time or write to: 

EIT Benefit Funds 

221 North La Salle Street, Suite 200 

Chicago, Illinois 60601-1214 

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Health Care

Retiree Health Care

Benefits 

You may be eligible for retiree health care benefits under this plan. 

As with active participants, benefits are contingent upon the 

continuation of the plan by the Trustees and on the financial 

adequacy of the plan. The Trustees reserve the right, in their sole 

and unrestricted discretion, to change, amend or end this coverage 

at any time for any reason. Examples of changes that may occur as 

retiree health care costs continue to rise include but are not limited 

to special retiree deductibles or copays, or caps on prescription 

drug expenses. 

Who’s Eligible 

You (and your eligible dependents) are eligible for retiree health care benefits if: 

1. You are receiving a benefit from and have 15 years of credited service 

earned after December 31, 1976 under Pension Plan No. 2 - OR - 

2. You have a combined total of at least 25 years of credited service under 

Pension Plan No. 2 and Pension Plan No. 4 (with a minimum of at least 10 

years of credited service having been earned under Pension Plan No. 2), and

You have been covered as an active employee under this plan throughout 

the two years before your retirement, or have at least 30 years of credited 

service under Pension Plan No. 2 - OR - 

3. On or after July 1, 2006 you have a combined total of at least 30 years of: 

− Credited service under Pension Plan No.2, and

− Eligibility service earned under Pension Plan No. 2 solely from your 

employment as a union business representative, apprentice school 

teacher or apprentice school administrator. 

How Your Retiree Health Care Benefits Work 

The lifetime maximum benefit per person is $2 million. This maximum benefit 

includes benefits paid before retirement. 

If You’re Not Medicare-Eligible 

Unless you retire on a disability pension, you are not eligible for retiree health 

care benefits until you reach age 62. When you reach age 62 (or if you retired on 

a disability pension), you will receive the same health care benefits as an active 

participant until you reach age 65 or become entitled to Medicare. 

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Health Care

If You Are or Become Medicare-Eligible 

You are eligible for the same health care benefits as active participants, but 

Medicare is the primary plan. That is, Medicare will pay benefit costs before the

plan pays. Expenses not reimbursable by Medicare may be covered by this plan

if you have followed Medicare procedures. You are expected to seek treatment 

from a provider that has been approved by Medicare and is eligible to receive 

reimbursement from Medicare. All Medicare eligible retirees and their medical 

eligible dependents must satisfy the EIT annual deductible before any benefits 

will be paid by the plan. 

The plan assumes you are covered for Part B of Medicare. If you don’t enroll for 

Medicare Part B coverage, you must pay the amount Medicare would otherwise

have paid (e.g. 80% of Medicare eligible expenses). The plan does not cover the 

cost of Medicare premiums. 

If You Die

If you die, your surviving spouse will remain eligible for coverage for 360 days, 

whether or not he or she is eligible for Medicare. Your spouse may then continue

coverage under COBRA for up to 36 months by paying the applicable premium 

(see “Continuing Coverage” on page 69). Your eligible dependent children will 

also remain eligible for coverage for 360 days. If your child stops attending school

during this time, he or she is eligible for 120 days of coverage from the last day of 

full-time attendance (not to exceed a total of 360 days, or past your dependents’ 

23rd birthday). 

For More Information

Contact the Fund Office for more information about retiree health care benefits 

that may apply for you. 

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Health Care

Glossary

The definitions included in this glossary will help you understand your plan

benefits. 

Active Employee 

A person who meets the definition of employee, who is actively at work or

available for work for a contributing employer, and who is not a retiree. 

Chiropractic and Naprapathic Care 

Skeletal adjustments, manipulation or other treatment (including naprapathy) in 

connection with the detection and correction by manual or mechanical means of 

structural imbalance or subluxation in the human body. Treatment is performed to 

remove nerve interference resulting from, or related to, distortion, misalignment or

subluxation of, or in, the vertebral column. 

Coinsurance 

The percentage of covered expenses you must pay after you have met your

annual deductible. For example, if you use an in-network provider, you pay 10% 

of the PPO negotiated rate for most medical procedures and the plan covers the

remaining 90%. 

Copay

A fee charged by the plan for certain health care services or care. For example, 

copays are charged at the time of a medical office visit or when you have 

prescriptions filled. This fee is usually a flat amount. 

Cosmetic Surgery

Plastic or reconstructive surgery or other services and supplies which improve,

alter or enhance appearance, whether or not performed or used for emotional or 

psychological reasons. 

Credited Service 

Credited service is used to determine the amount of your pension benefit under 

Pension Plan No. 2. It also may be used to determine eligibility for health care 

coverage after you retire. 

Generally, you receive one full year of credited service for each calendar year in 

which you have 1,600 hours of covered employment. Before 1976, you received 

one-fourth of a year of credited service for each 400 hours you worked during

each year — up to the maximum full year of credited service. After 1975, you 

receive one full year of credited service for each year in which you work 1,600 

hours. For each year in which you have at least 400, but fewer than 1,600 hours, 

you receive credited service in proportion to your number of hours — up to the 

maximum full year of credited service. 

Refer to the Electrical Contractors’ Association (ECA) and Local 134 International 

Brotherhood of Electrical Workers (I.B.E.W.) Joint Pension Trust Pension Plan

No. 2 for more information on credited service. 

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Health Care

Deductible 

The amount you pay for covered services each year before the plan begins to 

pay benefits.

Durable Medical Equipment (DME) 

Medical equipment that can withstand repeated use without significant 

deterioration. DME is primarily and customarily used to serve a medical purpose,

and generally is not useful to a person in the absence of an illness or injury. DME 

is covered when it is designed and medically necessary to assist an injury or 

illness of the covered person and is appropriate for use in the home. 

Eligibility Service 

Eligibility service is used to determine when you qualify for a pension under 

Pension Plan No. 2. It also may be used to determine eligibility for health care 

coverage after you retire. 

You receive one year of eligibility service for each calendar year in which you 

have at least 400 hours of covered employment. Generally, covered employment

includes any period of work for which your employer is obligated to make 

contributions to the plan. You also receive one year of eligibility service for each 

calendar year in which you have at least 1,000 hours of non-covered employment 

with a participating employer. The 1,000-hour period must immediately precede

or follow covered employment with the same employer. Refer to the ECA and 

Local 134 I.B.E.W. Joint Pension Trust Pension Plan No. 2 for more information 

on eligibility service. 

Home Health Care (HHC)

Physician-ordered services for part-time or intermittent home nursing care by a 

licensed HHC organization when continued hospitalization would otherwise have

been required if home care was not provided. 

Hospice Care

Services provided for a terminally ill person. To be considered “terminally ill,” the 

covered individual must provide a statement from the attending physician 

indicating life expectancy to be six months or less. Hospice care programs 

provide either home care or inpatient care through an affiliated hospital or nursing 

facility. 

Industry Employment 

The term “industry employment” means any period of employment in which a 

participant is engaged in any capacity, whether as an employee, sole proprietor, 

owner-operator, independent contractor, self-employed person or otherwise, 

within the trade and geographic jurisdiction of the Union. 

In-Network (PPO Provider) 

A health care service or supply furnished by a PPO network provider. In general,

in-network services are covered at a higher benefit level than out-of-network 

services.

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Health Care

Investigational/Experimental 

Procedures, drugs, devices, services and/or supplies which are: 

• Provided or performed in special settings for research purposes or under a 

controlled environment and which are being studied for safety, efficiency and 

effectiveness; and/or 

• Awaiting endorsement by the appropriate National Medical Specialty College 

or federal government agency for general use by the community at the time 

they are rendered to a covered person; and 

• Specifically with respect to drugs, combination of drugs and/or devices, are 

not finally approved by the Federal Drug Administration at the time used or 

administered to the covered person. 

Lifetime Maximum 

The total amount of benefits you can receive under the plan in your lifetime. 

Medical Services Advisory (MSA) 

Blue Cross/Blue Shield (BCBS) Medical Service Advisory is the organization 

responsible for precertifying or authorizing medical services received from a 

hospital or other inpatient facility (see “Medical Service Advisory” on page 43).

Medically Necessary (Medical Necessity)

Health care services and supplies that are: 

• Determined by the claims administrator to be medically appropriate,

• Necessary to meet the basic health needs of the patient, 

• Rendered in the most cost-efficient manner and setting appropriate for the 

delivery of the service or supply, 

• Consistent in type, frequency and duration of treatment with scientifically 

based guidelines of national medical, research or health care coverage 

organizations, or governmental agencies that are accepted by the claims

administrator, 

• Consistent with the diagnosis of the condition, 

• Required for reasons other than the convenience of the patient or physician, 

and 

• Demonstrated through prevailing peer-reviewed medical literature to be 

either: 

− Safe and effective for treating or diagnosing the sickness or condition for 

which their use is proposed, or 

− Safe with promising efficacy for treating a life-threatening sickness or 

condition in a clinically controlled research setting using a specific

research protocol that meets standards equal to those defined by the 

National Institutes of Health. 

Morbid Obesity

A condition that exists when weight is at least twice the ideal weight for frame, 

age, height and gender, according to the Federal Guidelines on Obesity. 

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Health Care

Occupational Therapy

Physician-ordered treatment by a licensed occupational therapist. The physically 

disabled person is treated by means of constructive activities designed and 

adapted to promote the functional restoration of the person’s abilities lost or 

impaired by disease or accidental injury to satisfactorily accomplish the ordinary 

tasks of daily living and those required by the person’s particular occupational 

role. 

Out-of-Area 

A medical care service or supply that is provided outside the PPO network area

(if you live more than 10 miles away from all in-network providers). 

Out-of-Network (Non-PPO Provider) 

A medical care service or supply furnished by a provider that does not participate 

in the PPO network. In general, out-of-network services are covered at a lower 

benefit level than services from a PPO network provider. 

Orthotic Devices 

Appliances such as braces and splints which are required for support for an 

injured or deformed part of the body as a result of a disabling congenital condition

or an injury or sickness. 

Out-of-Pocket Maximum

The most you pay out-of-pocket in a calendar year for eligible medical expenses. 

If your deductible plus coinsurance toward eligible expenses reaches the out-ofpocket maximum, the plan pays 100% for most additional covered expenses for 

the rest of the calendar year. (In-network office visit copays and amounts charged 

by out-of-network providers above negotiated rates or U&C charges do not count 

toward the out-of-pocket maximum.)

Participant 

A person who is employed by an employer participating in the EIT benefit plan 

and for whom contributions are being received by EIT. 

Participating Provider Option (PPO) 

A medical organization that allows you to choose from a list of participating 

providers. The providers agree to provide appropriate medical care for negotiated 

rates to plan participants. You pay less for services when you use participating 

PPO providers because their charges are based on the PPO negotiated rates. 

Physical Therapy

Physician-ordered treatment by a licensed physical therapist using physical 

means, hydrotherapy or biomechanical and neurophysiological principals. 

Plan Administrator 

The plan administrator controls and manages the operation and administration of

the benefits and programs of a plan. The Trustees serve as the plan administrator 

for the Electrical Insurance Trustees Health & Welfare Plan for Construction 

Workers. 

Preventive Care 

Health care services intended to prevent or provide early diagnosis of illness or

injury, such as routine physical exams, gynecological exams, well-child care and 

immunizations. 

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Health Care

Referral Hall 

The Referral Hall refers to the Union office where members must register their 

availability for work and from where employment is assigned. 

Skilled Nursing Facility (SNF) 

A licensed facility that provides 24-hour professional nursing services on an 

inpatient basis to persons convalescing from injury or sickness. SNFs maintain a

complete medical record on each service recipient and are supervised on a fulltime basis by a physician. 

Speech Therapy

Speech therapy as directed by a physician and performed by a licensed speech 

therapist. Treatment is covered by the plan if the services are expected to restore 

a speech function lost due to disease, injury or surgery. 

Timely Filing

The length of time in which a claim must be filed in order to receive benefits. 

Usual and Customary (U&C) Charges

The charges considered appropriate in your geographic area for medically 

necessary services, treatments, supplies or drugs. You pay any charges over the 

U&C amount.

Welfare Fund 

Refers to the assets held in trust for the EIT Benefit Funds Health & Welfare Plan

for Construction Workers. 

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Disability 

Your plan provides you with disability coverage that gives you and 

your family protection against some of the financial hardships that 

can occur if you become disabled or injured. The benefits include:

More Information 

For definitions of terms 

that are often used in 

describing your benefits, 

be sure to review the 

“Glossary” on page 92 of 

this section and in the 

Health Care section of 

this SPD. 

• Short-Term Disability benefits 

• Long-Term Disability benefits 

In addition to these benefits, you may also be eligible for benefits 

from Pension Plan No. 2, Pension Plan No. 5, the Additional 

Security Benefit (ASB) Plan and Social Security. See the What 

Happens If... section for more information. 

In This Section See Page 

Participation ....................................................................................................... 82

Participant Eligibility ...................................................................................... 82

When Coverage Begins ................................................................................ 83

When Coverage Ends ................................................................................... 83

Filing a Claim................................................................................................. 83

What’s Not Covered ...................................................................................... 84

Short-Term Disability Benefits ......................................................................... 85

When Benefits Begin and End ...................................................................... 86

Receiving Benefits......................................................................................... 86

Recurring Disabilities .................................................................................... 86

Long-Term Disability Benefits.......................................................................... 87

When Benefits Begin and End ...................................................................... 87

Qualifying for a Benefit.................................................................................. 88

Receiving Benefits......................................................................................... 88

Recurring Disabilities .................................................................................... 89

Pension Plan Disability Benefits.................................................................... 89

Social Security Disability Benefits ................................................................. 89

Disability Advancement................................................................................. 89

Rehabilitative Employment............................................................................ 90

Permanent and Total Disability Benefits: Life Insurance Conversion ......... 91

Glossary.............................................................................................................. 92

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Disability

Participation 

This section describes how you can participate in disability benefits, 

including who is eligible, when disability coverage begins, 

maintaining disability coverage and when disability coverage ends. 

Participant Eligibility 

If you are an active employee and you are eligible for health benefits, you are 

eligible for disability benefits. 

If you stop working in active employment or become ineligible for health benefits 

under the plan, your eligibility for disability benefits will end. Once your eligibility 

ends, you will not be eligible for disability benefits until you resume coverage as

an active employee under the health plan. 

See “Participant Eligibility” in the Health Care section for more information about

health plan eligibility requirements. 

Maintaining Coverage by Self-Pay

Insufficient Contributed 

Hours

It is solely your

responsibility to know

when your coverage will

end due to insufficient 

contributed hours. Notice 

of loss of coverage from 

the Fund Office is not an 

obligation of the Welfare 

Fund, its Trustees or the 

Fund Office. 

Generally, once you become eligible, your disability coverage will continue under 

the Electrical Insurance Trustees Health & Welfare Plan as long as sufficient 

contributions to maintain your eligibility are received by the Fund Office on your

behalf. 

However, if your coverage would end because sufficient contributions have not 

been received to meet the contributed hours requirement, you may maintain your 

coverage by making self-pay contributions if you meet the requirements under 

the plan. 

For more information about maintaining your coverage, refer to “Maintaining 

Coverage by Self-Pay” in the Health Care section.

Credited Hours During Periods of Disability

If you are unable to work because of a certified disability, you are credited with up

to 25 hours for each week of proven disability while eligible for short-term 

disability or long-term disability benefits during any one period of continuous 

disability. 

To receive credited hours, you must be: 

• Receiving disability benefits from Workers’ Compensation or from the 

Welfare Fund, or 

• Eligible for but not receiving benefits from the Welfare Fund because Social 

Security disability benefits are greater. 

Insurance eligibility credit will be given for up to 118 weeks if you were covered

under the plan for at least 12 consecutive months prior to the disability or for up to 

14 weeks if you were covered for fewer than 12 consecutive months prior to the

disability. 

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Disability

When Coverage Begins 

Short-term disability coverage begins on the first day of the month after you 

complete the plan’s eligibility requirements (see “Participant Eligibility” in the 

Health Care section). 

Eligibility for long-term disability coverage begins on the first day of the month 

after you have been enrolled in the Health & Welfare Plan for 12 consecutive 

calendar months. 

When Coverage Ends 

Coverage ends when you fail to meet eligibility requirements or if the plan is

discontinued. The following table summarizes situations in which coverage would 

normally end and what happens to your coverage in each situation.

It is solely your 

responsibility to know

when your coverage will

end due to insufficient 

contributed hours. Notice 

of loss of coverage from 

the Fund Office is not an 

obligation of the Welfare 

Fund, its Trustees or the 

Fund Office. 

Important Note

You can receive benefits 

for up to a maximum of 2 

years and 14 weeks. 

Disability Coverage 

Ends... 

However, Disability Coverage May Continue 

if... 

If you are laid off and are 

unemployed

You are eligible to make self-pay contributions 

and are registered through the Referral Hall and 

available for work. 

If you work outside the 

jurisdiction of Local Union 

134 

You work for a contributing employer outside 

Local Union 134 jurisdiction and you register on 

the Electronic Reciprocal Transfer System

(ERTS) to have your contributions transferred to 

this plan. 

If the plan is discontinued No further coverage is available. 

The Trustees will make every effort to notify you by mail if you lose coverage for 

any reason. The notice will be sent to the address on file at the Fund Office. Be 

sure to notify the Fund Office if you have a change of address. 

Note: You must reimburse the plan for any benefits that may have been paid 

after you have lost coverage because of insufficient hours. 

Filing a Claim 

To collect short-term disability or long-term disability benefits, you must contact 

the Fund Office and obtain a claim form. The Fund Office will send a claim form 

to you. It must be completed by you, your employer and your physician and 

returned to the Fund Office. The completed claim form must be filed with the 

Fund Office within 365 days from the date of your disability. You also must supply 

the Fund Office with information the Trustees require (i.e., proof of your claim). 

The Fund Office will forward your completed claim form to a third-party case 

management service for medical review before any benefits are paid. All benefits 

are subject to certification by the case management service. 

Benefits are not available for any claim that began more than 365 days before 

receipt of the completed claim form by the Fund Office. In addition, if the Fund 

Office determines that you received short-term disability or long-term disability 

benefits to which you were not entitled, you will be required to reimburse the 

Fund for any benefit payments made to you. 

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Disability

Proof of Claim 

Your proof of claim must show: 

• That you are under the regular care of a licensed physician or behavioral 

health provider, 

• The date your disability began, 

• The cause of your disability, 

• The extent of your disability — including restrictions and limitations 

preventing you from performing your regular job, and 

• The name and address of any hospital or facility where you received 

treatment, as well as all attending physicians. 

EIT Benefit Funds reserves the right to request an independent exam by a 

selected physician to review your eligibility for disability benefits. 

Refer to “Claims Approval and Denial” in the Rules, Regulations and 

Administrative Information section for more claims information. 

What’s Not Covered 

You will not receive benefits for any period of disability: 

Important Note!

See the “What’s Not 

Covered” list for 

exclusions that apply to 

both short-term disability 

and long-term disability

benefits. 

• During which you are not under the regular care of a licensed physician or

behavioral health provider,

• During which your disability is not certified by the case management service, 

• During which you are treated by a relative or a person who ordinarily resides 

with you, 

• That results from injury or sickness caused directly or indirectly by war or an 

act of war, 

• Caused by participation in a riot, 

• That results from intentionally self-inflicted injury, 

• For which you are paid by an employer,

• That results from an accident while intoxicated or under the influence of 

narcotics not administered by a physician, 

• That results from an injury or sickness arising from any electrical work or any 

other paid work or is payable under any Workers’ Compensation or

occupational disease law, 

• That results from travel in a private aircraft, or 

• That occurs after the date you retire. 

These exclusions apply to both your short-term disability and your long-term 

disability benefits. 

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Disability

Short-Term Disability 

Benefits 

You receive short-term disability benefits if you are disabled by an 

illness or accidental injury while an active employee. The disability 

must prevent you from returning to work with a participating 

employer and make you totally unable to perform your job. You also

must be under the care of a licensed physician or behavioral health 

provider during your disability. 

The chart below summarizes the short-term disability benefits 

offered under the plan. To fully understand how these benefits 

work, you should read the more detailed information that follows the 

chart. 

Short-Term Disability Benefits 

When Coverage 

Begins 

On the first day of the month after you become eligible for 

health and welfare benefits under this plan 

When Benefits 

Are Payable 

After you are unable to work and have been under the care 

of a licensed physician or behavioral health provider for 

seven consecutive days 

What You 

Receive 

$750 a week for up to 13 consecutive weeks 

How Long 

Benefits Last

If you remain totally disabled and your disability continues to 

be certified by a case management service, payments 

continue for up to 13 weeks. 

Other Benefits You remain eligible for health and welfare benefits. 

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Disability

When Benefits Begin and End 

Your benefits will begin after you are unable to work for seven consecutive days, 

What’s the Definition of and you are under the care of a licensed physician or behavioral health provider.

Disability?

You are considered 

disabled if you suffer from 

an illness or accidental 

injury that prevents you 

from being continuously

able to perform your job, 

and you are under the 

care of a licensed 

physician or behavioral 

health provider. 

If you remain totally disabled, payments continue for up to 13 weeks, but not 

beyond the date your physician allows you to return to work. 

See “What’s Not Covered” on page 84 for exclusions and limits that apply to 

disability benefits under the plan. 

Receiving Benefits 

You will receive the benefit shown in the “Short-Term Disability Benefits” chart on

page 85 at the end of each pay period during which you have provided proof of 

your continuing disability. Because of federal law, Social Security and Medicare

taxes will be withheld from your weekly short-term disability benefit. If you want 

federal income and state taxes withheld from your check, you must notify the 

Fund Office. 

Recurring Disabilities 

If you recover from a short-term disability, return to work and are later disabled 

again from the same cause, the two periods will count as one 13-week disability 

period, unless your physician released you for full-time unrestricted work and: 

• The disabilities are separated by four consecutive weeks of full-time 

employment where you are doing the same or similar work as you did before 

your disability, or 

• You are registered with the Referral Hall and available for work and did not 

turn down gainful employment for at least four consecutive weeks. 

If you recover from one short-term disability and then become disabled from a 

different cause, you will receive benefits for up to 13 weeks for each period of 

disability if: 

• Your physician allowed you to return to full-time unrestricted work between 

the two periods of disability, and 

• You either returned to full-time unrestricted work or registered with the 

Referral Hall and were available for work and did not turn down gainful 

employment. 

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Disability

Long-Term Disability 

Benefits 

You may receive long-term disability benefits for up to 24 months 

while you continue to be disabled and under a physician’s care. 

Applying for Social

Security Disability

Benefits 

If your disability is 

expected to last six 

months or longer, you are 

expected to apply for 

Social Security disability 

benefits. 

The chart below summarizes the long-term disability benefits 

offered under the plan. To fully understand how these benefits 

work, you should read the more detailed information that follows the 

chart. 

Long-Term Disability Benefits 

When Coverage 

Begins 

On the first day of the month after you have been enrolled in 

the Health & Welfare Plan for 12 consecutive months 

When Benefits 

Are Payable 

After 14 weeks of disability (13 weeks of short-term disability 

plus the seven day short-term disability waiting period) 

What You 

Receive 

60% of your average monthly pay (minimum monthly benefit 

of $2,000, up to a maximum monthly benefit of $3,000). The 

benefit will be reduced by any disability benefit paid or 

payable by Social Security 

How Long 

Benefits Last

Your benefits will continue for up to 24 months after they 

begin as long as you remain disabled or until you retire, 

whichever comes first. 

Other Benefits 

while You Are 

Disabled 

• You remain eligible for health and welfare benefits 

• You may qualify for a benefit from Pension Plan No. 5 

• You may qualify for a Social Security disability benefit 

• If you become totally and permanently disabled, you

may qualify to have your Basic Life Insurance benefits 

converted to 114 monthly installment payments 

Note: After your long-term disability benefits end, you may qualify to continue 

medical, prescription drug, dental, orthodontia, vision and hearing aid benefits for 

up to 29 months by paying premiums as available through COBRA. (See 

“Continuing Coverage” in the Health Care section for more information about 

COBRA continuation of coverage.) COBRA does not include disability benefits. 

You may also qualify for a benefit from Pension Plan No. 2. If you are eligible for 

a disability pension, you may also qualify for retiree health care coverage. 

When Benefits Begin and End 

Your long-term disability benefits begin after 14 weeks of disability. (During this

14-week period, you may be eligible for short-term disability benefits — see 

“Short-Term Disability Benefits” on page 85.) 

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Disability

Your benefits end at the first instance of any of the following circumstances: 

• The disability ends 

• 24 months after benefits begin 

• When you receive a disability award from Social Security and elect to receive 

a pension from EIT 

Qualifying for a Benefit 

To qualify for long-term disability benefits, you must: 

• Be covered by the Health & Welfare Plan for at least 12 consecutive calendar 

months before the disability began, 

• Be prevented from performing any gainful work due to a physical or mental 

impairment, 

• Not have engaged in any gainful employment for 14 consecutive weeks, 

• Be under the continuous care and attendance of a licensed physician or 

behavioral health provider or surgeon for treatment of your disability, and 

• Have applied for Social Security disability benefits and your application is still 

pending, or be eligible to receive Social Security benefits. 

The Fund Office determines disability and the right of any participant to receive 

disability benefits from the plan. 

See “What’s Not Covered” on page 84 for exclusions and limits that apply to 

disability benefits under the plan. 

Receiving Benefits 

Your long-term disability benefit is paid monthly for up to 24 months after benefits 

Average begin. The benefit amount is based on the formula shown below: Monthly Pay

Average monthly pay

means the wages or salary

paid to you by participating 

employers in the 12 

calendar months before 

your disability began, 

divided by 12. 

60% of your average monthly pay

(minimum monthly benefit of $2,000, up to a maximum monthly benefit of $3,000) 

MINUS 

Disability benefits paid or payable by Social Security or any other group 

disability plan 

An Example: Since your benefit is 60% of your average monthly pay, if your 

average monthly pay is $3,333 or less, your monthly benefit will be $2,000. If your 

monthly pay is between $3,333 and $5,000, you will receive 60% of your average 

monthly pay. If your average monthly pay is more than $5,000, your maximum 

benefit is $3,000 per month. 

Any disability benefits paid or payable by Social Security or any other group 

disability plan will reduce the benefits payable by this plan. 

Vacation and holiday pay, bonuses and commissions are not included in figuring 

your long-term disability benefit. 

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Disability

Recurring Disabilities 

If you recover and are then disabled again within six months from the same or a 

related cause, you are considered to have a continuation of the first disability. If 

more than six months have passed since your recovery, and you have worked 

doing the same or similar work for six consecutive months as you did before your 

first disability, you are considered to have a new disability for which you may 

receive up to 24 months of benefits, subject to a 14-week waiting period. 

Pension Plan Disability Benefits 

If you become totally and permanently disabled (see “Permanent and Total 

Disability Benefits: Life Insurance Conversion” on page 91), and have been 

granted a disability benefit from Social Security, you may be eligible to receive: 

• The value of your account in Pension Plan No. 5, if applicable, and 

• If you have 10 or more years of eligibility service, a disability pension from 

Pension Plan No. 2. However, if you start your disability pension,

payments from this plan will stop. 

Social Security Disability Benefits 

Social Security may also provide disability benefits to you and your eligible family

members. You must apply for a Social Security disability benefit within five 

months of disability to remain eligible for long-term disability benefits through this 

plan. If your initial application for Social Security disability benefits is denied, you 

must pursue your right to appeal the denial. That means you must complete each 

of the following steps on a timely basis until your claim is allowed: 

• A reconsideration 

• A hearing before an administrative law judge 

• A review by an Appeals Council 

• An action in a federal district court 

In each step, you must apply in writing within 60 days of notification that your 

appeal was not granted at the earlier step. 

After you have been eligible for Social Security disability benefits for 24 months, 

you become eligible for Medicare — regardless of your age. This is another 

important reason to pursue your claim for Social Security benefits throughout the 

entire appeals process. 

Once you have applied for Social Security disability benefits, you may be eligible

to receive your Additional Security Benefit (ASB) Plan account balance if your 

disability has continued for at least six consecutive months. To request your ASB 

Plan Account balance, contact the Fund Office. 

Disability Advancement 

The Trustees may grant you a short-term emergency advance from the plan while 

you wait for the determination of your right to receive Social Security disability 

benefits. Contact the Fund Office for an application. 

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Disability

The advancement is secured by your benefit under this plan or any benefits that 

you may receive from the Trustees. On approval by the Trustees, you will receive 

up to one month of your long-term disability benefit. You can apply for an 

advance once each month until Social Security has made a final determination on

your right to disability benefits. The advancement must be paid back to the 

Trustees within 30 days after you receive a Social Security disability benefit. 

If your application for Social Security disability benefits is not approved after you 

have completed the entire appeal process, as stated under “Social Security 

Disability Benefits” on page 89, the advancement would revert to the basic longterm disability benefit and would not have to be repaid. 

Rehabilitative Employment 

Your long-term disability benefit will continue if you participate in rehabilitative 

employment, but it will be reduced by 80% of your income from such 

employment. The reduction may apply for the whole 24-month benefit period. 

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Disability

Permanent and Total 

Disability Benefits: Life

Insurance Conversion 

If you become totally and permanently disabled while an active 

employee under age 70, you may convert your Basic Life Insurance 

benefit of $10,000 (see “Life Insurance Benefits” in the Life 

Insurance and AD&D section) to a series of monthly installment 

payments. It is to your advantage to start these payments after your 

long-term disability benefits have ended. 

Monthly Benefit Amounts 

You may convert your Life Insurance benefit to a series of 114 monthly 

installment payments (91⁄2 years). The first monthly installment is $148.50 and the 

remaining installments are $100 a month. Because of interest, the total amount of 

the benefit over the 114-month span would be $11,448.50. If you die while 

receiving these benefits, any unpaid installments are payable monthly to your 

designated beneficiary, or your designated beneficiary may elect to receive any

unpaid principal balance in a lump-sum payment. 

Benefits are currently being administered by Fort Dearborn Life Insurance 

Company. 

Proving Your Disability

You are considered totally and permanently disabled if: 

• A physical or mental impairment prevents you from working within the 

electrical industry, 

• The impairment is expected to continue for at least 24 months or result in an 

earlier death, and 

• You are eligible to receive a Social Security disability benefit. 

The loss of sight in both eyes, or the severance of both hands or feet or one hand

and one foot, is also considered total and permanent disability. 

You must furnish the Trustees with proof of disability (including your Social 

Security award) within 365 days after it begins. The Trustees, or an agent 

selected by the Trustees, have the right to require proof of the continuing 

disability at any time during the first two years of disability, and once a year 

thereafter. Payments stop if you fail to furnish satisfactory proof of your disability. 

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Disability

If your disability ends before all 114 installments have been made, your $10,000

Life Insurance benefit will be reduced by the amount of Permanent and Total 

Disability benefits paid. The exact amount of your Life Insurance benefit coverage 

is figured based on a table provided by Fort Dearborn Life Insurance Company. 

(A copy of this table is available at the Fund Office for your review.) The full 

$10,000 will be restored if you produce a statement of health satisfactory to the 

Trustees and return to active employment with a participating employer or 

register with the Referral Hall and remain available for work and do not turn down 

gainful employment. 

Glossary

The definitions included in this glossary will help you understand your plan

benefits. 

Active Employee 

A person who meets the definition of employee, who is actively at work or

available for work for a contributing employer, and who is not a retiree. 

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Life Insurance and 

AD&D 

The plan provides you with life and accident coverage that gives 

you and your family protection against some of the financial 

hardships that can occur if you become injured or die. These 

benefits include: 

More Information... 

For definitions of terms 

that are often used in 

describing your benefits, 

be sure to review the 

“Glossary” on page 101 of 

this section and in the 

Health Care section of 

this SPD. 

• Basic Life Insurance 

• Accidental Death & Dismemberment (AD&D) 

In addition to these benefits, you or your spouse or beneficiary may 

also be eligible for benefits from Pension Plan No. 2, Pension Plan 

No. 5, the Additional Security Benefit (ASB) Plan and Social 

Security. See the What Happens If... section for more information. 

In This Section See Page 

Participation ....................................................................................................... 94

Participant Eligibility ...................................................................................... 94

When Coverage Begins ................................................................................ 94

When Coverage Ends ................................................................................... 95

Designating a Beneficiary ............................................................................. 95

Other Benefits Payable on Death.................................................................. 96

Filing a Claim................................................................................................. 96

Life Insurance Benefits ..................................................................................... 97

Conversion Privilege ..................................................................................... 97

What’s Not Covered ...................................................................................... 98

Accidental Death & Dismemberment (AD&D) Benefits ................................. 99

Receiving Benefits......................................................................................... 99

What’s Not Covered .................................................................................... 100

Glossary............................................................................................................ 101

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Life Insurance and AD&D 

Participation 

This section describes how you can participate in Life Insurance 

and AD&D (accidental death and dismemberment) benefits, 

including who is eligible, when Life Insurance and AD&D coverage 

begins, maintaining Life Insurance and AD&D coverage and when 

Life Insurance and AD&D coverage ends. 

Participant Eligibility 

If you are an active employee and you are eligible for health benefits, you are 

eligible for Life Insurance and AD&D benefits. 

If you stop working in active employment or become ineligible for health benefits 

under the plan, your eligibility for Life Insurance and AD&D benefits will end. 

Once your eligibility for health benefits ends, you will not be eligible for Life 

Insurance and AD&D benefits until you resume coverage as an active employee

under the health plan. 

If you are a retiree who retired under the early pension benefit provision (as 

stated in the Electrical Insurance Trustees Pension Plan No. 2 SPD), you have 

not attained age 65 and you are eligible for health benefits, you are not eligible for 

AD&D benefits but you are eligible for Life Insurance benefits. However, your Life 

Insurance coverage will end when you reach age 65 or you lose your eligibility for 

health benefits. 

See “Participant Eligibility” in the Health Care section for more information about

health plan eligibility requirements. 

Maintaining Coverage by Self-Pay

Generally, once you become eligible, your Life Insurance and AD&D coverage

will continue under the Electrical Insurance Trustees Health & Welfare Plan as

long as sufficient contributions to maintain your eligibility are received by the 

Fund Office on your behalf. 

Insufficient Contributed 

Hours

It is solely your

responsibility to know

when your coverage will

end because of insufficient 

contributed hours. Notice 

of loss of coverage is not 

an obligation of the 

Welfare Fund, its Trustees 

or the Fund Office. 

However, if your coverage would end because sufficient contributions have not 

been received to meet the contributed hours requirement, you may maintain your 

coverage by making self-pay contributions if you meet the requirements under 

the plan. 

For more information about maintaining your coverage, refer to “Maintaining 

Coverage by Self-Pay” in the Health Care section.

When Coverage Begins 

Coverage begins on the first day of the month after you complete the plan’s 

eligibility requirements. See “Participant Eligibility” in the Health Care section for 

details. 

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Life Insurance and AD&D 

When Coverage Ends 

Coverage ends when you fail to meet eligibility requirements or if the plan is

discontinued. The following table summarizes situations in which coverage would 

normally end and what happens to your coverage in each situation.

It is solely your 

responsibility to know

when your coverage will

end due to insufficient 

contributed hours. Notice 

of loss of coverage from 

the Fund Office is not an 

obligation of the Welfare 

Fund, its Trustees or the 

Fund Office. 

Life Insurance and 

AD&D Coverage 

Ends... 

However, Life Insurance and AD&D Coverage May

Continue if... 

If you are laid off and 

are unemployed 

You are eligible to make self-pay contributions and are 

registered through the Referral Hall and available for 

work. 

If you work outside 

the jurisdiction of 

Local Union 134 

You work for a contributing employer outside Local 

Union 134 jurisdiction and you register on the 

Electronic Reciprocal Transfer System (ERTS) to have 

your contributions transferred to this plan. 

If the plan is 

discontinued 

No further coverage is available. 

The Trustees will make every effort to notify you by mail if you lose coverage for 

any reason. The notice will be sent to the address on file at the Fund Office. Be 

sure to notify the Fund Office if you have a change of address. 

Designating a Beneficiary 

You may designate anyone you want as your beneficiary by completing and 

returning the beneficiary designation form available from the Fund Office. Your 

beneficiary designation applies to both Basic Life Insurance and the AD&D 

accidental death benefit. You may change your beneficiary designation at any 

time by filing a new beneficiary designation form with the Fund Office. Completed 

beneficiary designation forms must be received by the Fund Office during your

lifetime. 

If there is no designated beneficiary still surviving at the time of your death, your

death benefit is divided equally among the then living members of the first 

surviving class listed below: 

• Your spouse

• Your children

• Your parents 

• Your estate 

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Life Insurance and AD&D 

Other Benefits Payable on Death 

In addition to the Life Insurance and AD&D benefits described in this section of 

the SPD, your surviving spouse or children may be eligible for a survivor benefit 

from Pension Plan No. 2 or to receive the balance of your ASB Plan and/or your 

account under Pension Plan No. 5. 

To apply for your pension or ASB plan benefits, your designated beneficiary may 

call or write to the Fund Office for benefit forms. Then, he or she must file the 

application with the Fund Office, which will submit it to the Trustees. Your 

designated beneficiary may be asked to supply evidence of age and any other 

additional information (such as a death certificate) the Trustees consider 

necessary. 

Depending on your age and other circumstances, your spouse may also be 

eligible to receive death benefits from Social Security. 

Filing a Claim 

To collect the Life Insurance benefit, your designated beneficiary must advise the 

Fund Office of your death and obtain a claim form. The completed claim form 

must be filed with the Fund Office within 365 days of the date of your death. Your

designated beneficiary must supply the Fund Office with information the Trustees 

require. 

To receive AD&D benefits, you or your designated beneficiary need to complete 

the following steps: 

• For a dismemberment benefit, you must contact the Fund Office to obtain a 

claim form. You must complete and return the claim form within 90 days of 

the date of the accident and provide other information, such as proof of loss, 

as requested.

• To receive the accidental death benefit under this coverage, your designated

beneficiary must complete and return the claim form within 365 days of the 

date of your death. He or she must also provide other information as

requested by the Trustees. 

Refer to “Claims Approval and Denial” in the Rules, Regulations and 

Administrative Information section for more claims information. 

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Life Insurance and AD&D 

Life Insurance Benefits 

If you die from any cause while you are an active employee or you are a retiree 

who retired under the early pension provision (as stated in the Electrical 

Insurance Trustees Pension Plan No. 2 SPD) and have not attained age 65 — 

and you are eligible for health benefits — the plan provides a Basic Life 

Insurance benefit. 

The chart below summarizes the Life Insurance benefits offered under the plan. 

To fully understand how these benefits work, you should read the more detailed

information that follows the chart. 

Life Insurance Benefits 

When Coverage 

Begins 

On the first day of the month after you become eligible for 

health benefits under this plan 

When Benefits Are 

Payable 

If you die while you are an active employee or a retiree 

who retired under the early pension provision and have 

not attained age 65 —and you are eligible for health 

benefits under this plan 

What You Receive • Your designated beneficiary will receive $10,000. 

• If you become totally and permanently disabled, your

Life Insurance benefit can be converted to 114 

monthly installments. (See the Disability section for 

more information.)

How Long 

Benefits Last

Your designated beneficiary will receive a one-time lumpsum benefit payment. 

Receiving Benefits 

Your Basic Life Insurance benefit is paid to your designated beneficiary as a 

single lump-sum payment.

However, please note that if you converted your Life Insurance benefit to monthly 

installments because of permanent and total disability, any installments you 

received will reduce the amount of your Life Insurance benefit, unless you 

recover and produce a statement of health satisfactory to the Trustees. (See

“Permanent and Total Disability Benefits: Life Insurance Conversion” in the 

Disability section.) 

Conversion Privilege 

If your Life Insurance coverage ends because you become totally and 

permanently disabled while you are an active employee covered under the 

Health & Welfare Plan, you may purchase an individual life insurance policy from

an insurance carrier designated by the Trustees, currently Fort Dearborn Life 

Insurance Company, without giving any evidence of insurability. Contact the Fund 

Office in advance for an application form and premium and coverage information. 

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Life Insurance and AD&D 

To use this conversion privilege, a written application and payment of the first 

premium must be made to and received by Fort Dearborn Life Insurance 

Company within 31 days after termination of coverage. The individual policy 

issued will be of the form used by the insurance company for conversion of group 

life insurance at the time conversion is made. The effective date will be the date

following the date coverage ends under the plan. 

What’s Not Covered 

No exclusions apply under Basic Life Insurance coverage. 

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Life Insurance and AD&D 

Accidental Death & 

Dismemberment (AD&D) 

Benefits 

If you die because of an accident while an active employee, the plan pays your 

designated beneficiary an accidental death benefit in addition to the Basic Life 

Insurance benefit. If you are injured in an accident and become dismembered, 

the plan pays a dismemberment benefit to you. 

The chart below summarizes the AD&D benefits offered under the plan. To fully 

understand how these benefits work, you should read the more detailed 

information that follows the chart. 

AD&D Benefits

When Coverage 

Begins 

On the first day of the month after you become eligible

for health benefits under this plan 

When Benefits Are 

Payable 

If, while you are eligible for this benefit, you die due to an 

accident or you are injured in an accident and become

dismembered

What You Receive • Your designated beneficiary will receive $5,000 in 

one lump-sum payment (in addition to your Basic 

Life Insurance benefit) if you die because of an 

accident. 

• You will receive up to $5,000 in one lump-sum 

payment if you become dismembered in an accident. 

How Long Benefits 

Last 

Benefits are paid to you or your designated beneficiary in 

one lump-sum payment if you die or are dismembered as 

a result of an accident. 

Other Benefits Not applicable 

Receiving Benefits 

An accidental death benefit will be paid to your designated beneficiary if you die 

as a direct result of an accident and independent of all other causes within 365 

days of the date of the accident. This accidental death benefit is in addition to any 

other life insurance (or death benefit) coverage you may have under a Local 134 

benefit plan. However, the benefit is reduced by the amount of any accidental 

dismemberment benefits paid as a result of the same accident. 

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Life Insurance and AD&D 

If, within 90 days of the date of an accident, you become dismembered due to 

that accident and you are an active employee, you may receive one of the 

following benefits: 

If a Covered Accident Results in... The Benefit Amount 

Payable Is... 

Covered Loss

Loss of both hands, both feet, the sight in both eyes, 

one hand and one foot, one hand or foot and sight of 

one eye, or hearing in both ears and speech 

$5,000 

Loss of one hand, one foot, the sight of one eye, loss of 

speech or hearing in both ears 

$2,500 

Loss of a thumb and index finger on the same hand $1,250 

Paralysis 

Quadriplegia (paralysis of both upper and both lower 

limbs) 

$5,000 

Paraplegia (paralysis of both upper or both lower limbs) 

or hemiplegia (paralysis of the upper and lower limbs on 

the same side of the body) 

$2,500 

Triplegia (hemiplegia with paralysis of a limb on the 

other side) 

$3,750 

Uniplegia (the entire and irrecoverable paralysis of one 

limb) 

$1,250 

Seat Belt and Air Bag Benefit 

The plan will pay to your designated beneficiary an additional $5,000 if you die in 

a private passenger car accident, and your seat belt was in use at the time of the 

accident. The plan will pay a $500 air bag benefit, in addition to the full benefit 

amount, if the air bag deployed. Based on the police report, if it cannot be 

determined whether the seat belt was in use at the time of the accident, then the 

benefit will be reduced to $1,000, and the plan will pay an additional $250 if the 

air bag deployed. 

What’s Not Covered 

Your AD&D benefit is not paid if death or dismemberment results from: 

• Bacterial infections (except pyogenic infections that occur with or through an 

accidental cut or wound), 

• Ptomaines, 

• Bodily or mental infirmity or any other kind of disease,

• Suicide or attempted suicide, 

• An act of war,

• Participation in a riot, 

• Commission of a felony, or 

• An act of terrorism. 

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Life Insurance and AD&D 

Glossary

The definitions included in this glossary will help you understand your plan

benefits. 

Active Employee 

A person who meets the definition of employee, who is actively at work or

available for work for a contributing employer, and who is not a retiree. 

Retiree 

A person who meets the applicable eligibility requirements as stated in the 

Electrical Insurance Trustees Pension Plan No. 2 SPD. 

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Life Insurance and AD&D 

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Rules, Regulations and 

Administrative 

Information 

This section contains important administrative information about the 

benefits provided to you by the Electrical Insurance Trustees and 

described in this handbook. The information in this section applies 

to all of your benefits and includes details about your rights as 

provided under the Employee Retirement Income Security Act of 

1974, as amended (ERISA). Although you may not need this 

information on a day-to-day basis, it is important for you to 

understand your rights and the procedures you need to follow 

should certain situations arise. 

Your benefits are sponsored and administered by a joint labormanagement Board of Trustees. The Fund Administrator assists the 

Board of Trustees in the administration of the Fund. The Fund 

Administrator and other personnel of the administration office are 

employees of the Fund Office. 

In This Section See Page 

Plan Documents............................................................................................... 104

Your Rights Under ERISA............................................................................... 104

Your HIPAA Rights .......................................................................................... 106

Claims Review and Appeals Procedures ...................................................... 107

Health Care ................................................................................................. 107

Disability and Life Insurance/AD&D Benefits .............................................. 108

Non-Assignment of Benefits .......................................................................... 109

Change or Termination of the Plan................................................................ 110

Other Plan Details............................................................................................ 110

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Rules, Regulations and Administrative Information 

Plan Documents 

This Summary Plan Description (SPD, or handbook) serves as the official plan 

document for the Electrical Insurance Trustees (EIT) Health & Welfare Plan for 

Construction Workers, and supersedes and replaces any prior SPD and 

Summaries of Material Modification previously provided by EIT for the plans of 

benefits described in it. If you need more information, you may examine copies of 

the applicable collective bargaining agreement and other related documents at 

the Fund Office. 

Your Rights Under ERISA 

As a participant in the EIT Health & Welfare Plan for Construction Workers, you 

are entitled to certain rights and protections under the Employee Retirement 

Income Security Act of 1974, as amended (ERISA). 

Although ERISA does not require an employer to provide benefits, it does set 

standards on how a plan is run. It also requires that you be kept fully informed of 

your rights and benefits — the details of which are included in this handbook. 

ERISA provides that all plan participants shall be entitled to the following rights: 

Receive Information about Your Plan and Benefits 

• You may examine, free of charge, all documents governing the plan including 

insurance contracts, collective bargaining agreements and the latest annual 

report (Form 5500 Series). These documents are available at the plan 

administrator’s office and at other specified locations. The annual report also 

is filed with the U.S. Department of Labor and is available at the Public 

Disclosure Room of the Employee Benefits Security Administration. 

• You may obtain copies of all documents governing the operation of the plan, 

including updated Summary Plan Descriptions by writing to the plan

administrator. The plan administrator may make a reasonable charge for the 

copies. 

• You may also receive a summary of the plan’s annual financial report. The 

plan administrator is required by law to furnish each participant with a copy of 

this summary annual report. 

Continue Group Health Plan Coverage 

• Under COBRA, you may continue health care coverage for yourself, your 

spouse or your dependents if there is a loss of coverage under the plan as a 

result of a qualifying event. However, you or your dependents may have to 

pay for such coverage. Review this SPD and the documents governing the 

plan for the rules governing your COBRA continuation coverage rights. 

Prudent Actions by Plan Fiduciaries 

• In addition to creating rights for plan participants, ERISA imposes duties upon 

the people who are responsible for operating the plan. These people are 

called “fiduciaries” of the plan. They have a duty to act prudently and in the 

interest of you and other plan participants and beneficiaries. 

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Rules, Regulations and Administrative Information 

• No one, including your employer or any other person, may fire you or 

otherwise discriminate against you in any way to prevent you from obtaining

a benefit to which you are otherwise entitled or from exercising your rights 

under ERISA. 

Enforcement of Your Rights 

• If your claim for a benefit is denied, in whole or in part, the plan administrator 

must give you a written explanation of the reason for the denial, and you can 

obtain copies of documents relating to the decision, without charge. You also 

have the right to have the plan administrator review and reconsider your 

claim, all within certain defined time schedules. 

• Under ERISA, there are steps you can take to ensure the above rights. For 

instance, if you request materials from the plan administrator and do not 

receive them within 30 days, you may file suit in a federal court. In such a 

case, the court may require the plan administrator to provide the materials 

and pay you up to $110 a day until you receive the materials, unless the 

materials were not sent because of reasons beyond the control of the plan 

administrator. 

• If your claim for benefits is denied or ignored, in whole or in part, you may file 

suit in a state or federal court. You may also file suit in a federal court if you 

disagree with a decision, or the lack of a decision, concerning the qualified 

status of a medical child support order. If plan fiduciaries misuse the plan’s 

money or if you are discriminated against for asserting your rights, you may 

seek assistance from the U.S. Department of Labor, or you may file suit in a 

federal court. 

• The court will decide who should pay court costs and legal fees. If you are 

successful, the court may order the person you have sued to pay these costs 

and fees. If you lose (for example, if the court finds your claim is frivolous), it 

may order you to pay these costs and fees. 

Assistance with Your Questions 

• If you have any questions about your plan, you should contact the plan 

administrator. If you have any questions about this statement or about your 

rights under ERISA, or if you need assistance in obtaining documents from 

the plan administrator, you should contact the nearest office of the Employee 

Benefits Security Administration, U.S. Department of Labor, listed in your 

telephone directory or contact the: 

Division of Technical Assistance and Inquiries 

Employee Benefits Security Administration 

U.S. Department of Labor 

200 Constitution Avenue N.W. 

Washington, D.C. 20210 

• You may also obtain certain publications about your rights and 

responsibilities under ERISA by calling the publication hotline of the 

Employee Benefits Security Administration. 

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Rules, Regulations and Administrative Information 

Your HIPAA Rights 

According to the Health Insurance Portability and Accountability Act of 1996 

(HIPAA), if you lose coverage under the plan, you are entitled to a certificate that 

shows evidence of your prior medical coverage. 

The claims administrator promptly provides this certificate: 

• If you or your covered dependents lose coverage under the plan, 

• If you or your dependents lose coverage under COBRA, or 

• Whenever you submit a written request within 24 months after either of the 

above events occurs. 

The certificate identifies: 

• Who was covered under the plan, 

• The period of coverage, and 

• Any waiting periods. 

This certificate is used to determine pre-existing condition exclusion periods in 

the future because, according to HIPAA, your period of coverage under this plan 

will offset the exclusion period of a new medical plan.

If you leave this plan and enroll in coverage under another medical plan, check 

with your new plan’s administrator to find out whether: 

• The plan has a pre-existing condition exclusion, and 

• You need to provide a certificate or other documentation of your medical 

coverage through this plan.

Under HIPAA, if you have creditable coverage from another plan, you are entitled 

to receive a certificate of coverage that helps to reduce or eliminate exclusionary 

periods of coverage for pre-existing conditions under your new group health plan. 

You will be provided a certificate of creditable coverage, free of charge, from the 

EIT Health & Welfare Plan for Construction Workers or your health insurance 

insurer when:

• You lose coverage under the plan, 

• You become entitled to elect COBRA continuation coverage, or

• Your COBRA continuation coverage ends. 

You may also request a certificate of coverage before your coverage ends, or for 

up to 24 months after losing coverage. 

Without evidence of creditable coverage, you may be subject to a pre-existing 

condition exclusion for 12 months (18 months for late enrollees) after you enroll in

your new coverage. 

EIT will assist you in obtaining a certificate of creditable coverage from your 

previous insurer if one is needed and you do not have one. 

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Rules, Regulations and Administrative Information 

Claims Review and Appeals Procedures 

In all circumstances relating to any claim or appeal for benefits under any plan, 

the plan administrator or claims administrator responsible for making a 

determination on the claim or appeal will have discretionary authority in making 

the determination, including but not limited to, interpreting and applying the terms 

and conditions of the plan, making any necessary factual determinations and 

determining eligibility under the plan. Benefits under the plan will be paid only 

when the Trustees, or persons delegated by them to make such decisions, 

decide in their sole discretion, that the participant or beneficiary is entitled to 

benefits under the terms of the plan. 

Health Care 

The plan has a specific amount of time, by law, to evaluate and respond to claims

for benefits covered by the Employee Retirement Income Security Act of 1974, as 

amended (ERISA). The period of time the plan has to evaluate and respond to a 

claim begins on the date the claim is first filed with the applicable claims 

administrators. 

You may file claims for plan benefits, and appeal adverse claim decisions, either 

yourself or through an authorized representative. If your claim is denied in whole 

or in part, you will receive a written notice of the denial from BCBS. The notice 

will explain the reason for the denial and the review procedures. 

An “authorized representative” means a person you authorize, in writing, to act on

your behalf. The plan will also recognize a court order giving a person authority to 

submit claims on your behalf, except that in the case of a claim involving urgent 

care, a health care professional with knowledge of your condition may always act 

as your authorized representative. 

If you have any questions regarding how to file or appeal a claim, contact the 

claims administrator. For more information on filing claims and claims

administrator’s addresses, please see “Filing a Claim” in each applicable benefit 

plan section and the Contact Information section.

Appealing Denied Claims 

If your claim is denied, in whole or in part, you may appeal the denial. You will 

receive a written notice explaining why and on which specific plan provisions the 

claim has been denied. The notice also will explain how to file an appeal. There 

are two levels of the appeals process, as described below. You must submit your 

first appeal to Blue Cross/Blue Shield (BCBS) within 180 days of the date of the 

BCBS non-favorable decision. If the BCBS appeal is not favorable, you may then 

request a second level of appeal with the Trustees within 180 days of the date of 

the BCBS non-favorable decision. You may choose to name an authorized 

representative to handle your appeal. 

A first level appeal is decided by a BCBS review unit that did not conduct the 

initial review of your claim. The timelines for deciding appeals will differ based 

upon the type of claim you file. 

A second level appeal is decided by the Board of Trustees after a full and fair 

review and is based upon the information submitted in the appeal and the terms 

of the plan. The timelines for deciding appeals will differ based upon the type of 

claim you file. 

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Rules, Regulations and Administrative Information 

If your appeal is: 

Note 

An appeal of a concurrent 

care decision to reduce or 

terminate previouslyapproved benefits may be 

an urgent care, pre-service 

or post-service claim, 

depending on the facts. 

• An urgent care claim: BCBS or CIGNA Behavioral Health will review your 

claim as applicable. The appeal will be decided as soon as possible, but no 

later than 72 hours after it is received (no extensions). 

• A non-urgent pre-service claim: BCBS or CIGNA Behavioral Health will 

review your claim. The appeal will be decided within 30 days after it is 

received, or 15 days for each level of appeal, if two mandatory appeals are 

allowed (no extensions). 

• A non-urgent post-service claim: The appeal must be decided within 60 

days after it is received, or 30 days for each level of appeal, if two mandatory 

appeals are allowed (no extensions). 

• Any other claim under the plan: The claim must be decided within 60 days 

after it is received (up to 60-day extension). 

The Trustees’ decision on a second level appeal is final. If either you or your

authorized representative still believes a claim for benefits has been improperly 

denied, you or your authorized representative may contact the plan administrator. 

You have the right to receive without charge, upon written request, reasonable 

access to any documents relied on in making this determination. Furthermore, if 

you believe the Trustees have erred in determining your rights under the Plan’s 

provisions, you have the right to bring a civil action under Section 502(a) of the 

Employee Retirement Income Security Act of 1974, as amended (ERISA). 

Besides having the right to appeal, you or your authorized representative can 

examine any documents, records and other information relevant to your denied 

claim. You can also submit, in writing, reasons why you think the claim should not 

be denied. 

If your claim for benefits is denied, you can file suit in a state or federal court. 

However, you may not initiate any action at law or in equity to recover under the

plan until you have exhausted the appeal rights described above and the plan 

benefits requested in that appeal have been denied in whole or in part. 

Disability and Life Insurance/AD&D Benefits 

Filing a Claim 

If your claim is approved, you will receive all applicable benefits as soon as the 

Fund Office receives and approves all necessary documentation.

If your claim is denied, you will receive a written explanation from the Fund Office

within 90 days from the time the application was received by the Trustees (or 

within 180 days if the Trustees notify you that additional time is needed for 

processing the application). This written notice includes: 

• Specific reasons for the denial, 

• References to the plan provisions on which the denial is based, 

• Descriptions of any additional information you may have to provide and why 

it’s needed, 

• Explanations of the plan’s claim review procedure including the steps to take 

if you or your beneficiary wish to appeal the decision, and 

• A statement of your right to bring a civil action lawsuit under ERISA section 

502(a) following a denial of your claim or review. 

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Rules, Regulations and Administrative Information 

Appealing a Claim 

You or an authorized representative may appeal any claim denial by filing a 

written request for a full and fair review by the Trustees. A request for a review 

must be filed within 180 days after you receive written notice of the denial. You 

may also review documents pertinent to the administration of the plan and submit

written comments and issues outlining the basis of the appeal. You may have 

legal representation throughout the review procedure.

The review on appeal will take into account any information you submit, even if it 

was not submitted or considered as part of the initial determination. Upon request 

and free of charge, you will also be provided reasonable access to and copies of 

all documents, records, and information relevant to your claim. 

The person filing the appeal may request a written answer, including specific 

reasons and references to pertinent plan provisions, within 60 days after the 

appeal is made (or within 120 days if special circumstances require additional 

time and the Trustees notify you that additional time is needed before the end of

60 days). 

The Trustees will provide you written notification of the decision on an appeal, 

usually within 45 days of when it is received (within 90 days in special cases). 

If your appeal is denied, the notification will: 

• Include specific reasons for the denial, 

• Refer to the specific plan provisions on which the determination is based, 

• State that you are entitled to receive, upon request and free of charge, 

reasonable access to or copies of all documents, records, or other 

information relevant to the claim, 

• Describe any voluntary appeal procedures offered by the plan and state your 

right to bring civil action under federal law, 

• Disclose any internal rule, guideline, protocol, or similar criterion relied on in 

making the adverse determination (or state that information will be provided 

free of charge upon request), and 

• If the denial on appeal is based on a medical necessity, experimental 

treatment or similar exclusion, explain the scientific or clinical judgment for 

the adverse determination (or state that an explanation will be provided free 

of charge upon request). 

The Trustees’ decision on an appeal is final. If you or your authorized 

representative still believe a claim for benefits has been improperly denied, you or 

your authorized representative may contact the plan administrator. 

Besides having the right to appeal, you or your authorized representative can 

examine any plan documents related to your claim. You can also submit, in 

writing, reasons why you think the claim should not be denied. If your claim for 

benefits is denied or ignored, you can file a suit in state or federal court, once you 

have exhausted all appeals and administrative remedies available under the plan. 

Non-Assignment of Benefits 

Generally, benefits from the plan belong to you. You may not sell, assign, transfer 

or garnish these benefits. 

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Rules, Regulations and Administrative Information 

Change or Termination of the Plan 

Although the Electrical Insurance Trustees intend to continue the plan indefinitely, 

the Trustees have the authority and unconditionally reserve the right, in their sole

and unrestricted discretion, to change, amend or end the plan at any time, or from 

time to time, for any reason. 

Changes may be made retroactively, if necessary, to qualify or maintain the 

benefits under the Internal Revenue Code or the Employee Retirement Income 

Security Act of 1974, as amended (ERISA). If the plan is amended or ends, you 

may not receive benefits as described in this handbook. However, you may be 

entitled to receive different benefits, or benefits under different conditions or no

additional benefits. 

Other Plan Details 

This section contains other important information about the administration and 

funding of the benefit plans described in this handbook. 

Plan Name

The official name of the plan is the Electrical Insurance Trustees Health & 

Welfare Plan for Construction Workers. This SPD describes the health care 

benefits (medical, prescription drug, dental, orthodontic, vision and hearing) and 

the welfare benefits (sickness, disability, life, and accidental death and 

dismemberment insurance) provided under the plan. 

Plan Administrator and Sponsor 

The plan administrator controls and manages the operation and administration of

the plan. The administrator and sponsor of the plan is:

Electrical Insurance Trustees 

221 North LaSalle Street, Suite 200 

Chicago, IL 60601-1214 

1-312-782-5442 

Employer Identification Number 

The employer identification number is 36-1033970. 

Plan Number 

The plan number is 501. 

Agent for Legal Process 

The agent for service of legal process concerning the plan is: 

Sean P. Madix 

Fund Administrator 

221 North LaSalle Street, Suite 200 

Chicago, Illinois 60601-1214 

Service may also be made on the Board of Trustees or an individual Trustee at 

the addresses listed under “Trustees.” 

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Rules, Regulations and Administrative Information 

Trustees 

The Trustees who authorize the plan benefits have authority to: 

• Resolve questions concerning the plan, 

• Make rules to implement the plan, 

• Construe the plan terms, and 

• Determine when plan benefits will be paid. 

As of January 1, 2008, the Trustees are as follows: 

Employer Trustees 

William T. Divane, Jr. 

Divane Bros. Electric Company 

2424 North 25th Avenue 

Franklin Park, Illinois 60131-3323 

1-847-455-7143 

Kevin M. O’Shea 

Shamrock Electric Company Inc.

1281 East Brummel Avenue 

Elk Grove Village, Illinois 60007 

1-847-593-6070 

I. Steven Diamond 

Malko Electric

6200 Lincoln Avenue 

Morton Grove, Illinois 60053-2851 

1-847-967-9500 

Kenneth Bauwens 

Jamerson & Bauwens Electrical Contractors, Inc. 

3055 MacArthur Blvd 

Northbrook, Illinois 60002

1-847-291-2008 

Michael R. Walsdorf 

Advent Systems, Inc.

435 West Fullerton Avenue 

Elmhurst, Illinois 60126-1404 

1-630-279-7171 

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Rules, Regulations and Administrative Information 

Union Trustees 

Timothy Foley 

Michael J. Caddigan 

Lawrence J. Crawley 

Samuel Evans 

James T. North 

600 West Washington Boulevard 

Chicago, Illinois 60661-2490 

1-312-454-1340 

Discretion of Trustees and Fund Administrator 

The Trustees and the Fund Administrator have full discretion in determining any

and all questions related to the plan, the fund or the operation of the plan. This 

discretion also applies to: 

• Any claim for benefits, 

• The construction of the language or meaning of the rules and regulations 

adopted by the Trustees, 

• This SPD and any amendments thereto, and 

• Any writing concerned with or provided in connection with the operation of the 

plan. 

Benefits under the plan will be paid only when the Trustees, or persons delegated 

by them to make such decisions, decide in their sole discretion, that the 

participant or beneficiary is entitled to benefits under the terms of the plan. The 

good faith decision of the Trustees or the Fund Administrator is binding upon 

anyone dealing with the plan or claiming any benefit under the plan. 

Plan Funding 

Coverage for you and your dependents under the plan is paid for by contributions

from the participating employers. The amount of the contribution is established by 

the collective bargaining agreement. Assets are held in trust by the Trustees and 

disbursed by them. 

Plan Year 

The plan year begins on July 1 and ends on the following June 30. 

For More Information

All questions and requests for information should be sent to the Trustees at the 

following address: 

Attention: Fund Administrator 

221 North LaSalle Street, Suite 200 

Chicago, Illinois 60601-1214 

You may also call 1-312-782-5442 for more information. 

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Contact Information 

This section shows you where to go for questions about your 

benefits. For claims filing information and addresses, see “Filing a 

Claim” in the applicable benefit plan sections. 

Claims Administrators 

For... Contact... At... 

Medical, Hearing Aid and Vision 

Medical benefit PPO network 

provider information, benefit 

information (including 

information hearing aid 

benefits), forms and claim

information 

Blue Cross/Blue 

Shield of Illinois 

(BCBS) 

1-800-862-3386 

www.bcbsil.com 

The Medical Services Advisory 

(MSA) Program (the plan’s 

utilization review organization) 

Blue Cross/Blue 

Shield of Illinois 

(BCBS) 

1-800-635-1928* 

www.bcbsil.com 

Hearing aid discounts EPIC 1-866-956-5400 

Vision services Vision Service 

Plan (VSP) 

1-800-877-7195 

www.vsp.com 

Behavioral Health and Substance Abuse 

Information on mental health 

and substance abuse benefits 

CIGNA Behavioral 

Health 

1-888-218-7210 

www.cignabehavioral.com

The Members Assistance 

Program (MAP) counseling and 

education information 

MAP (CIGNA

Behavioral 

Health) 

1-888-218-7210 

Prescription Drug Information 

Prescription drug information, 

order forms and preaddressed 

envelopes for mail service 

CVS/Caremark 1-800-566-5693

www.caremark.com

P.O. Box 94467 

Palatine, Illinois 60094 

Dental and Orthodontia

Dental and orthodontia benefit 

information, forms and claim 

information 

Blue Cross/Blue 

Shield of Illinois 

(BCBS) 

1-800-862-3386 

www.bcbsil.com 

BlueCare® Freedom 

Dental PPO

P.O. Box 23059 

Belleville, Illinois 62223 

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Contact Information 

For... Contact... At... 

Disability Benefits 

Short-term and long-term 

disability benefit information, 

forms and claim information 

EIT Fund Office 1-312-782-5442 

Life Insurance and AD&D Benefits

Life insurance and AD&D

benefit information, forms and 

claim information 

EIT Fund Office 1-312-782-5442 

* Monday through Friday, 7:00 a.m. through 7:00 p.m. Central Time. Weekend and after-hours 

emergency calls are answered by an answering service. 

Fund Office

Electrical Insurance Trustees (EIT) 

221 North La Salle Street, Suite 200 

Chicago, Illinois 60601-1214 

1-312-782-5442 

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