SUPPLEMENT. to the WESTERN PENNSYLVANIA ELECTRICAL EMPLOYEES INSURANCE TRUST FUND SICKNESS AND DISABILITY BENEFITS PROGRAM.

Transcription

1 SUPPLEMENT to the WESTERN PENNSYLVANIA ELECTRICAL EMPLOYEES INSURANCE TRUST FUND SICKNESS AND DISABILITY BENEFITS PROGRAM April 2013 BUS_EST:

2 TABLE OF CONTENTS Page Introduction Eligibility to Participate in the Sickness and Disability Benefits Program Ineligibility for Sickness and Disability Benefits Sickness and Disability Benefits Coverage Provided by the Insurance Trust Fund Reimbursement of Sickness and Disability Benefits and Subrogation Application for Benefits Amendment or Termination of Program... 5 Appendix A Application Procedure and Example for Sickness and Disability Benefits... 6

3 Introduction The Sickness and Disability Benefits Program is part of the Western Pennsylvania Electrical Employees Insurance Trust Fund. The Program provides weekly Sickness and Disability Benefits to eligible participants in the Program who are unable to work because of sickness or disability. This Supplement to the Summary Plan Description for the Insurance Trust Fund describes the Sickness and Disability Benefits available to you under the Program. It describes only the Sickness and Disability Benefits. You should refer to the Summary Plan Description for the Insurance Trust Fund for a description of the general provisions that apply to the payment of the Health and Welfare Benefits. If you have any questions as to your eligibility for Sickness and Disability Benefits or the amount of the Benefits, you should contact the Benefits Administrator ( ). - 1 of 6 -

4 1-1 Eligibility to Participate in the Sickness and Disability Benefits Program You are eligible to participate in the Sickness and Disability Benefits Program if you meet the following requirements: you are a currently eligible participant in the Western Pennsylvania Electrical Employees Insurance Trust Fund; and you promptly notify the Benefits Administrator at at the onset of your sickness or disability; and you have been eligible for benefits in at least three of the preceding five benefit quarters; and you are actively employed under a Collective Bargaining Agreement requiring contributions to be made to the Insurance Trust Fund at the rate established for participation in the Sickness and Disability Benefits Program; and you are unable to work at your job as a result of a physical sickness or physical disability including, for this purpose, treatment for alcohol and/or drug addiction; and you furnish a certificate from a licensed Medical Doctor which substantiates to the satisfaction of the Trustees the existence of your sickness or disability and your inability to work at your job as the result of your sickness or disability; and you submit an updated doctor's certificate monthly. 1-2 Ineligibility for Sickness and Disability Benefits You will not be eligible for the Sickness and Disability Benefits described in Section 1-3 if: you are not covered under the Insurance Trust Fund; or you are not actively employed under a Collective Bargaining Agreement providing for contributions to the Insurance Trust Fund at a rate established for participation in the Sickness and Disability Benefits Program; or your sickness or disability is a mental sickness or mental disability; or you receive any wages or salary from an employer (including self-employment income) while sick or disabled; or - 2 of 6 -

5 you are receiving workers' compensation or you have received a workers' compensation settlement for a job-related injury connected with or arising out of your current sickness or disability; or you are receiving unemployment compensation benefits; or you are receiving any type of retirement or disability pension under the Western Pennsylvania Electrical Employees Pension Plan, the National Electrical Benefit Fund, or any pension plan covered under a Reciprocal Agreement; or you are permanently disabled (i.e. receive a final Social Security Notice of Award); or you fail to agree in writing to reimburse the Insurance Trust Fund for the amount of Sickness and Disability Benefits you receive if you are awarded workers' compensation benefits (applies to participants eligible to apply for workers' compensation benefits); or you are not under the care of a licensed Medical Doctor for your sickness or disability; or you are able to return to work at your job; or you sign the referral book for employment or otherwise give notice of your availability to work; or you die. At any time, the Trustee may require that you undergo a medical examination by a licensed Medical Doctor of their choice to determine your eligibility or continued eligibility to receive Sickness and Disability Benefits. If you refuse to be examined by a licensed Medical Doctor, you will not be eligible to receive Sickness and Disability Benefits (until you are examined by the licensed Medical Doctor and found eligible by the Trustees for the Benefits). - 3 of 6 -

6 1-3 Sickness and Disability Benefits Sickness and Disability Benefits are paid weekly beginning with the second week that you are unable to work at your job as the result of your sickness or disability. The weekly benefit is equal to 50% of your weekly base wage (including vacation pay), subject to a maximum weekly benefit of $ and a minimum weekly benefit of $ For this purpose, your weekly base wage is calculated by multiplying your regular hourly wage by 40 (partial weeks will be prorated accordingly). The payment of Sickness and Disability Benefits is subject to applicable income tax withholding and employment taxes. No more than 26 weeks of Sickness and Disability Benefits are paid in any single, consecutive 52-week period. All Sickness and Disability Benefits will stop if you: are able to return to work to your job; or receive wages or salary from an employer (including self-employment income); or sign the referral book for employment or otherwise give notice of your availability to work; or receive any type of retirement or disability pension under the Western Pennsylvania Electrical Employees Pension Plan, the National Electrical Benefit Fund, or any pension plan covered under a Reciprocal Agreement; or become permanently disabled (i.e. receive a final Social Security Notice of Award) and begin receiving disability benefits; or receive workers' compensation; or receive unemployment compensation benefits; or fail to provide income tax returns and/or payroll records to the Trustees to verify your eligibility for Sickness and Disability Benefits, if requested by Trustees; or refuse to undergo a medical examination by a licensed Medical Doctor selected by the Trustees, if requested; or die. 1-4 Coverage Provided by the Insurance Trust Fund The Insurance Trust Fund shall maintain health benefits for all participants receiving Sickness and Disability Benefits pursuant to this Sickness and Disability Benefit Program during the time the participant is sick or disabled. The participant shall be credited with eight hours per day, up to 40 hours per week, up to a maximum of 400 hours per quarter. - 4 of 6 -

7 1-5 Reimbursement of Sickness and Disability Benefits and Subrogation If you receive any Sickness and Disability Benefits under this Program that you are not eligible to receive, you will be required to repay those Sickness and Disability Benefits to the Insurance Trust Fund. If Sickness and Disability Benefits are paid or payable to you as a result of the act or omission of another person or party, the Insurance Trust Fund has the right to be subrogated to any of recovery that you may have against the third party. This is explained in more detail in the Summary Plan Description for the Insurance Trust Fund. 1-6 Application for Benefits You must apply for the Sickness and Disability Benefits on an application form available from the Benefits Administrator at The Trustees have the complete and sole discretion to determine your eligibility for Sickness and Disability Benefits. If your application is denied, you may appeal to the Trustees. 1-7 Amendment or Termination of Program The Trustees have the right to amend or terminate the Sickness and Disability Benefits Program at any time and for any reason. - 5 of 6 -

8 APPENDIX "A" APPLICATION PROCEDURE AND EXAMPLE OF SICKNESS AND DISABILITY BENEFITS CALCULATION A. Application Procedure If you sustain a sickness or disability which results in an inability to perform your job, you should: 1) Seek treatment by a licensed Medical Doctor; and 2) Notify the Benefits Administrator at ; and 3) Complete an application; and 4) Submit the application along with a certificate from the Medical Doctor. If approved, you will receive a weekly benefit for a maximum of 26 weeks beginning the second week that you are unable to work as a result of the sickness or disability. You will be paid in accordance with section 1-3, page 3 of the Sickness and Disability Benefits Program, Supplement to the Western Pennsylvania Electrical Employees Insurance Trust Fund. You must furnish an updated Medical Doctor's certificate monthly. B. Example of Sickness and Disability Benefits Calculation: Assume your regular hourly rate is equal to $20.00 plus $1.00 vacation or $21.00 per hour. Your regular weekly salary is equal to $21.00 x 40 hours or $ Your weekly Sickness and Disability Benefit would be equal to 50% of your weekly salary up to a maximum of $ In this example, your weekly Sickness and Disability Benefit would be $ x 50% or $420.00* **. If your weekly salary was $1,000.00, then your Sickness and Disability Benefit would be $ (Even though 50% of your weekly salary is $500.00, the maximum amount which may be received is $450.00). BUS_EST: *The payment of Sickness and Disability Benefits is subject to applicable income tax withholding. **The Insurance Trust Fund will provide matching Social Security contributions. - 6 of 6 -