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Service Employees 32BJ North Health Fund
Tri-State Preferred North Summary Plan Description (SPD)
>> General Information
Employer Contributions
The Plan receives contributions in accordance with collective
bargaining agreements between the Bronx Realty Advisory Board, Inc.,
the Boiler Service Maintenance and Repair Employers Association of New
York, Inc., or various independent employers, and your union. These
collective bargaining agreements provide that employers contribute to the
Fund on behalf of each covered employee. Employers that are parties to
such collective bargaining agreements may also participate in the Fund
on behalf of non-collectively bargained employees, if approved by the
Trustees, by signing a participation agreement.
The Fund Office will provide you, upon written request, with
information as to whether a particular employer is contributing to the
Fund on behalf of participants working under a collective bargaining
agreement or participation agreement and, if so, to which Plan the
employer is contributing.
How Benefits May Be Reduced, Delayed or Lost
 ALERT:
06/10/10 NEW
Click here for important benefit changes>>
There are certain situations under which benefits may be reduced,
delayed or lost. Most of these circumstances are spelled out in this booklet,
but benefit payments also may be affected if you, your beneficiary or your
provider of services, as applicable, do not:
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file a claim for benefits properly or on time
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furnish the information required to complete or verify a claim
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have a current address on file with the Fund Office
You should also be aware that Plan benefits are not payable for
enrolled dependents who become ineligible due to age, marriage, divorce
or legal separation (unless they elect and pay for COBRA benefits, as described in the "Continued Group Health Coverage" section).
If the Plan mistakenly pays more than you are eligible for, or pays
benefits that were not authorized by the Plan, the Fund may seek any
permissible remedy allowed by law to recover benefits paid in error (also see the "Overpayments" section and the "Subrogation and Reimbursement" section ).
Compliance with Federal Law
The Plan is governed by regulations and rulings of the Internal
Revenue Service and the Department of Labor, and current tax law. The
Plan will always be construed to comply with these regulations, rulings
and laws. Generally, Federal law takes precedence over state law.
Plan Amendment or Termination
The Board intends to continue the Plan indefinitely, but reserves
the right to amend or terminate it in its sole discretion. If the Plan
is terminated or otherwise amended, it will not affect your right to
receive reimbursement for eligible expenses you have incurred prior to
termination or amendment.
Upon a full termination of the Plan, Plan assets will be applied to
provide benefits in accordance with the applicable provisions of the Trust
Agreement and Federal law.
Keep in mind that the benefits provided under the Plan are not vested.
This is true for retirees as well as active employees. Therefore, at any time
the Board can end or amend benefits, including retiree benefits, in its sole
and absolute discretion.
Plan Administration
The Plan is what the law calls a “health and welfare” benefits
program. Benefits are provided from the Fund’s assets. Those assets are
accumulated under the provisions of the Trust Agreement and are held in
a Trust Fund for the purpose of providing benefits to covered participants
and dependents and defraying reasonable administrative expenses.
The Plan is administered by the Board of Trustees. The Board governs
this Plan in accordance with an Agreement and Declaration of Trust. The
Board and/or its duly authorized designee(s) has the exclusive right, power
and authority, in its sole and absolute discretion, to administer, apply and
interpret the Plan established under the Trust Agreement, and to decide
all matters arising in connection with the operation or administration of
the Plan established under the Trust. Without limiting the generality of
the foregoing, the Board and/or its duly authorized designees, including
the Appeals Committee with regard to benefit claim appeals, shall have the
sole and absolute discretionary authority to:
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take all actions and make all decisions with respect to the eligibility
for, and the amount of, benefits payable under the Plan
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formulate, interpret and apply rules, regulations and policies necessary
to administer the Plan in accordance with the terms of the Plan
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decide questions, including legal or factual questions, relating to the
calculation and payment of benefits under the Plan
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resolve and/or clarify any ambiguities, inconsistencies and omissions
arising under the Plan, as described in this SPD, the Trust Agreement
or other Plan documents
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process and approve or deny benefit claims and rule on any benefit
exclusions, and
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determine the standard of proof required in any case.
All determinations and interpretations made by the Board and/
or its duly authorized designee(s) shall be final and binding upon all
participants, eligible dependents, beneficiaries and any other individuals
claiming benefits under the Plan.
The Board has delegated certain administrative and operational
functions to the Fund staff, other organizations and to the Appeals
Committee. Most of your day-to-day questions can be answered by
Member Services or Fund Office staff. If you wish to contact the Board,
please write to:
Board of Trustees
Service Employees BJ North Health Benefit Fund
140 Huguenot Street
New Rochelle, NY 10801
Statement of Rights under the Employee Retirement Income
Security Act of 1974 as Amended
As a participant in the Service Employees 32BJ North Health
Benefit Fund, you are entitled to certain rights and protections under
the Employee Retirement Income Security Act of 1974 (ERISA). ERISA
provides that all Plan participants shall be entitled to:
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Examine, without charge, at the Fund Office, all documents governing
the Plan, including insurance contracts, collective bargaining
agreements, participation agreements and the latest annual report
(Form 5500 series) filed by the Plan with the U.S. Department of Labor
and available at the Public Disclosure Room of the Employee Benefits
Security Administration (EBSA).
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Obtain, upon written request to the Fund Office, copies of documents
governing the operation of the Plan, including insurance contracts,
collective bargaining agreements, participation agreements, the latest
annual report (Form 5500 series) and an updated Summary Plan
Description.
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Receive a summary of the Plan’s annual financial report. The Board
is required by law to furnish each participant with a copy of this
summary annual report.
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Continue Group Health Coverage. You may continue group health
coverage for yourself, spouse or dependents if there is a loss of
coverage under the Plan as a result of a Qualifying Event. You or your
dependents may have to pay for such coverage. See "Continued Group Health Coverage" for
information about COBRA. If you change medical plans and wish to
have any pre-existing conditions covered, you will need a Certificate of
Creditable Coverage. You can get this free of charge from your group
health plan or health insurance company when you lose coverage,
when you become entitled to elect COBRA continuation coverage,
when your COBRA continuation coverage ceases, if you request it
before losing coverage, or if you request it 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 your enrollment date in your new coverage.
In addition to creating rights for Plan participants, ERISA imposes
duties upon the people who are responsible for the operation of the
Plan. The people who operate your Plan, called “fiduciaries” of the
Plan, have a duty to do so prudently and in the interest of you and other
Plan participants and beneficiaries. No one, including your employer,
your union or any other person, may fire you or otherwise discriminate
against you in any way to prevent you from obtaining a welfare benefit or
exercising your rights under ERISA.
If your claim for a benefit is denied or ignored, in whole or in part, you
have a right to know why this was done, to obtain copies of documents
relating to the decision without charge, and to appeal any denial, all within
certain time schedules.
Under ERISA, there are steps you can take to enforce the above rights.
For instance, if you request a copy of Plan documents or the latest annual
report from the Plan 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 administrator.
If you have a claim for benefits which is denied or ignored, in whole
or in part, you may file suit in a state or Federal court after you have
exhausted the Plan’s appeal process. If it should happen that Fund
fiduciaries misuse the Fund’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 Federal court. You may not file a lawsuit
until you have followed the appeal procedures described in the "Appealing Denied Claims" section.
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, the court may order you to pay these costs and fees,
for example, if it finds your claim is frivolous.
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
EBSA, U.S. Department of Labor, listed in your telephone directory, or the:
Division of Technical Assistance and Inquiries
Employee Benefits Security Administration (EBSA)
U.S. Department of Labor
200 Constitution Avenue N.W.
Washington, DC 20210
You may also obtain certain publications about your rights and
responsibilities under ERISA by calling the publications hotline of EBSA
or by visiting the Department of Labor’s website: http://www.dol.gov.
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