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KERN COUNTY ELECTRICAL WORKERSCONSTRUCTION WIREMEN AND CONSTRUCTIONELECTRICIANHEALTH AND WELFARE TRUSTLOCAL UNION #428SUMMARY PLAN DESCRIPTION (SPD) / PLAN RULESEffective July 1, 2022#5729617v4/01337.017
TABLE OF CONTENTSINTRODUCTION. 1QUICK REFERENCE CHART . 4ELIGIBILITY RULES . 5COBRA CONTINUATION COVERAGE . 17MEDICAL, PRESCRIPTION DRUG AND VISION BENEFITS . 27DENTAL BENEFITS . 28LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE . 29GENERAL PROVISIONS AND INFORMATION REQUIRED BY ERISA . 30APPENDICES . 42i
INTRODUCTIONWHAT THIS DOCUMENT TELLS YOUThis Summary Plan Description (SPD)/Plan Rules describes the eligibility provisions for benefits forActive Employees and eligible Dependents along with a description of COBRA benefits, and generalprovisions of the group health plan (“the Plan” of the Kern County Electrical Workers ConstructionWiremen and Construction Electrician Health and Welfare Trust. This document also highlights theinsured medical/vision, dental and life and accidental death and dismemberment (AD&D) benefits of thePlan.This document is the Summary Plan Description/Plan Rules with an Appendix that includes some benefithighlights from the separate insurance companies including the Medical Plan (which includes a visionbenefit) issued by Kaiser, the Dental Plan issued by Anthem, and Life and AD&D Insurance issued byMetLife. Please contact the Trust Office if you need a copy of the medical/vision, dental, or life andAD&D Evidence of Coverage documents.The Plan described in this document is effective July 1, 2022. To determine if you are in a class of individuals who are eligible for benefits under this Plan, refer tothe Eligibility chapter in this document. Coverage for eligible dependents will be conditioned onyou providing proof of dependent status, satisfactory to the Plan. Note that your eligibility or right to benefits under this Plan should not be interpreted as a guaranteeof employment.This document will help you understand and use the benefits provided by the Kern County ElectricalWorkers Health and Welfare Trust for Construction Wiremen and Construction Electricians. You shouldreview it and share it with those members of your family who are or will be covered by the Plan. It willgive all of you an understanding of the coverages provided; the procedures to follow in submitting claims;and your responsibilities to provide necessary information to the Plan.While recognizing the many benefits associated with this Plan, it is also important to note that notevery expense you incur for health care treatment and services is covered by this Plan.All provisions of this document contain important information. If you have any questions about yourcoverage or your obligations under the terms of the Plan, be sure to seek help or information. A QuickReference Chart to sources of help or information about the Plan appears in this chapter.This Plan is established under and subject to the federal law, Employee Retirement Income Security Actof 1974, as amended, commonly known as ERISA. The medical/vision, dental, and life insurance of thePlan are insured by contracting with various insurance companies.IMPORTANT: TRUST BENEFITS ARE SUBJECT TO CHANGEThe rules providing benefits to Active Employees and eligible Dependents of the Kern County ElectricalWorkers Construction Wiremen and Construction Electricians Health and Welfare Trust for are subjectto change at any time by the Board of Trustees. No benefit presently provided either to Active Employeesor eligible Dependents is guaranteed to remain in the plan of benefits in the future.No Active Employee, or eligible Dependent, has a right to continue receiving the same eligibility andcoverage of benefits as exist now or may have existed in the past. The benefits do not become “vested”at any length of employment or upon retirement.The Trust attempts to maintain financial reserves which are adequate to pay claims already incurred andclaims likely to be incurred under eligibility earned by Active Employees but does not maintain reservesfor future eligibility of Active Employees or Retirees. The Trust pays current premiums for benefits fromcurrent contributions by employers. The Trust will pay premiums to the respective insurance carriers so1
long as sufficient funds are available. However, all benefits are subject to changes in the rules governingbenefits, and the Board of Trustees may make such rule changes effective on whatever date best servesthe interests of the Trust and its participants.IMPORTANT INFORMATIONKern County Electrical Workers Construction Wiremen and Construction ElectricianHealth and Welfare Trust is committed to maintaining health care coverage for employeesand their families at an affordable cost; however, because future conditions cannot bepredicted, the Board of Trustees reserves the right to amend or terminate coverages at any timeand for any reason.As the Plan is amended from time to time, you will be sent information explaining the changes.If those later notices describe a benefit or procedure that is different from what is describedhere, you should rely on the later information.Be sure to keep this document, along with notices of any Plan changes, in a safe andconvenient place where you and your family can find and refer to them.AUTHORIZED SOURCE OF INFORMATIONWhen benefits are provided by insurance contracts or health maintenance organizations (HMO’s), thelegal policy and terms of any group master contracts issued to the Plan will govern the interpretation ofquestions regarding the subject matter in this booklet.The only source of authorized information is this booklet and riders, if any, the most recent version of theAgreement and Declaration of Trust of the Kern County Electrical Workers Construction Wiremen andConstruction Electricians Health and Welfare Trust, the Rules and Regulations and the written statementsof the Trust Administrator and its authorized agents located in Bakersfield, California. Statements orrepresentations made by individuals other than those designated personnel are not authoritative sources ofinformation. Questions as to eligibility, benefits and other matters should be submitted in writing to theTrust Office located at 3805 North Sillect Avenue, Bakersfield, California 93308.DISCRETIONARY AUTHORITY OF PLAN ADMINISTRATOR AND DESIGNEESThe Board of Trustees has full discretion and authority to interpret the rules, contracts and other documentsestablishing the plans benefits, including but not limited to the rules of eligibility, and to decide any factualquestion related to eligibility for and the type and amount of benefits.In carrying out their respective responsibilities under the Plan, the Trust Administrator or itsdelegate/designee, other Plan fiduciaries, and the insurers or administrators of each Program of the Planhave been delegated and have discretionary authority to interpret the terms of the Plan including, but notlimited to the discretionary authority to resolve ambiguities or inconsistencies in the Plan and to determinethe extent to which a person is eligible and entitled to any Plan benefits.Any interpretation or determination made under that discretionary authority will be given full force andeffect, unless it can be shown that the interpretation or determination was arbitrary and capricious. Anyinterpretation or determination by the Plan Administrator or its delegate/designee, made in good faithwhich is not contrary to law, is conclusive on all persons affected.2
IMPORTANT NOTICEYou or your Dependents must promptly furnish to the Trust Office informationregarding change of name, address, marriage, divorce or legal separation, death ofany covered family member, change in status of a Dependent Child, change in thestatus of a Domestic Partnership, Medicare/Medicaid enrollment or disenrollment,or the existence of other coverage.Notify the Trust Office preferably within 31 days, but no later than 60 days, afterany of the above noted events.Failure to give the Trust Office a timely notice (as noted above) may cause you,your Spouse and/or Dependent Child(ren):a. to lose the right to obtain COBRA Continuation Coverage, orb. may cause the coverage of a Dependent Child to end when it otherwise mightcontinue because of a disability, orc. may cause claims to not be able to be considered for payment until eligibilityissues have been resolved, ord. may result in your liability to repay the Plan if any benefits are paid to anineligible person.Again, IF YOU FAIL to properly notify the Trust Office there areSIGNIFICANT CONSEQUENCES!!SPANISH LANGUAGE ASSISTANCESi usted no entiende la información en este documento, por favor de ponerse en contacto con personal deldepartamento de Administracion en 661-325-9471.QUESTIONS YOU MAY HAVEIf you have any questions concerning eligibility or the benefits that you or your family are eligible toreceive, please contact the Trust Office at their phone number and address located on the Quick ReferenceChart in this document. As a courtesy to you, the Trust Office staff may respond informally to oralquestions; however, oral communications are not binding on the Plan and cannot be relied upon in anydispute concerning your benefits.Your most reliable method is to put your questions into writing and fax or mail those questions to theTrust Office and obtain a written response from the Plan. In the event of any discrepancy between anyinformation that you receive from the Trust Office, orally or in writing, and the terms of this document,the terms of this document will govern your entitlement to benefits, if any.3
FOR HELP OR INFORMATIONWhen you need information, please check this document first. If you need further help, call the peoplelisted in the following Quick Reference Chart:QUICK REFERENCE CHARTInformation NeededWhom to ContactTrust Office/Administrative Office Eligibility for Coverage Plan Benefit Information Filing a Claim for Disability Benefits Medicare Part D Notice of CreditableCoverage COBRA Administration Assistance understanding the insured benefitsof the PlanMedical Plans for Active Employees Medical Plan Network Provider Directory Medical Claims and AppealsConstruction Benefits Administration, Inc.3805 North Sillect AvenueBakersfield, CA 93308Phone: (661) 325-9471Fax: (661) 325-9498Dental Plans Dental Network Provider Directory Dental Claims and AppealsAnthem Blue CrossDental Net (DHMO) Dental Plan21555 Oxnard StreetWoodland Hills, CA 91367(800) 627-0004https://www.anthem.com/caVisionLife InsuranceSee Kaiser Permanente contact info aboveMetLife200 Park AvenueNew York, NY 10166-0188Phone: (800) 275-4638Construction Benefits Administration, Inc.3805 North Sillect AvenueBakersfield, CA 93308Phone: (661) 325-9471Secure Fax: (661) 325-9498COBRA Administrator Information About Coverage Adding or Dropping Dependents Cost of COBRA Continuation Coverage COBRA Premium paymentsSecond Qualifying Event and DisabilityNotificationHIPAA Privacy Officer and HIPAA SecurityOfficer HIPAA Notice of Privacy PracticeKaiser PermanenteMember Services: (800) 464-4000 (toll-free)www.kp.orgHIPAA Privacy Officer and HIPAA Security Officerfor the Kern County Electrical Workers Health andWelfare TrustConstruction Benefits Administration, Inc.3805 North Sillect AvenueBakersfield, CA 93308Phone: (661) 325-9471Secure Fax: (661) 325-94984
ELIGIBILITY RULESHOURLY ACTIVE EMPLOYEESEligibility Requirements.If you are an Active Employee under one of the following class codes:CW1P, CW2P, CW1, CW2, CW3, CW4, CW5, CW6, CE1, CE2 AND CEF.you earn 1 Credit Hour for each hour for each hour of Covered Employment during which youcontribute toward single coverage and 2 Credit Hours for each hour of Covered Employment duringwhich you contribute toward family coverage If you are an Active Employee, you will be eligible forbenefits on the first day of the second month following the Work Month in which you have accrued 300Credit Hours or more in Covered Employment (600 if you elect family coverage) for whichcontributions must be paid to the Trust. The Credit Hours must be accrued during no more than 12consecutive work months. Note that you accrue hours in the month that you perform the coveredwork even though the contributions to the fund are generally made in the month following themonth in which you work.Example: New EmployeeJuly100 HoursAugust75 HoursSeptember60 HoursOctober65 HoursTotal Hours Accrued 300 HoursEmployee has accumulated the required 300 hours through October. Therefore, the Employee is eligiblefor benefits on the first day of December—the second month following October. There is no coverage forNovember, which is often referred to as the lag month.The term “Active Employee” used throughout this SPD is defined as a person who is employed by anemployer obligated to pay hourly contributions to the Plan pursuant to a collective bargaining agreementor persons who are not currently employed by an employer obligated to pay hourly contributions pursuantto a collective bargaining agreement, but who have hours in their Hour Bank (see Reserve Hours Accountsection on page 6) sufficient to maintain coverage under the Plan.Waiver of 300 Hour Requirement for Certain Active Participants Contributing to Related Plans.Under circumstances where you would otherwise be ineligible to immediately participate in the Planbecause (a) you are transferring to the Plan due to a change in job classification or (b) previously hadcoverage under the FMCP Plan 14 for Construction Wiremen and Construction Electricians or the KernCounty Electrical Workers Jouneyman and Apprentice Health and Welfare Plan and have not accrued thenecessary Credit Hours for participation, the 300 or 600 Credit Hour provision will be waived. As such,you will be eligible for benefits under this Plan on the first day of the second month following the monthin which you worked 125 hours.5
Continuation of Eligibility.Eligibility for benefits is continued on a month-to-month basis and is determined by the number of hoursworked (125 hours equals 1 month of coverage). See the detailed description in the Reserve HoursAccount section.Example: Previously Eligible EmployeeReserve Hours Account at the end of December*Deduction for January coverageAddition for December hours reported in JanuaryReserve Hours Account at the end of January500 hours125 hours100 hours475 hours* This includes the November hours reported in December.Reserve Hours Account (Hour Bank).1. Subject to the provisions set forth below, after you have met the eligibility requirements forcoverage, a Reserve Hours Account shall be established for you. Your initial Reserve HoursAccount will be credited with the hours you worked for which your initial eligibility wasdetermined. Each month thereafter, your Reserve Hours Account will be credited with hoursworked in the prior month for which contributions are made, or are required to be made, on yourbehalf by one or more contributing employers and 125 or 250 Credit Hours will be deducted fromyour account for that months benefit coverage. In no event shall the number of hours in yourReserve Hours Account exceed 625 hours (1,250 if electing two party or family coverage).2. The purpose of the Reserve Hours Account is to benefit you if you are temporarily unemployedand actively seeking covered employment with a contributing employer. The Reserve HoursAccount shall not benefit you if you accept employment performing duties of the nature coveredby any Collective Bargaining Agreement made by the Union, but for which no contributions arepayable by the employer to the Trust.3. No Hours Account shall be available to you if, at any time after beginning to accrue the hoursaccumulated in the Reserve Hours Account, you agree with or help a contributing employer tounderpay contributions to the Trust in violation of the applicable Collective BargainingAgreement. In addition, if at any time after the start of the work month you accept, or continue in,employment of the type covered by any Collective Bargaining Agreement requiring contributionsto the Trust, but for which no contributions are payable by the employer to the Trust, you cannotuse your Reserve Hours Account. You will only be able to use it if you work 125 Credit Hours ormore (250 if electing two party or family coverage) for which contributions are made, or requiredto be made, to the Trust in any month within the 12 work months following the date on which thisprohibited noncontributory employment begins.4. If you engage in any of the activities prohibited by the provisions of the paragraph(s) above, youshall be treated as if you had no hours accumulated in a Reserve Hours Account. You shall notifythe Trust Office promptly whenever either of the circumstances described above occurs. In theevent the Trust receives information that you are not entitled to accumulate hours in a ReserveHours Account for either reason stated above, you shall not be able to use the Reserve HoursAccount immediately and you shall be given written notice of the grounds for the action taken.You shall have sixty (60) days after such notice within which to file a written request for reviewof the action, together with any evidence showing entitlement to a Reserve Hours Account. If youfail to make a request for review within sixty (60) days, suspension of the Reserve Hours Accountshall become final. Trust Determinations regarding all review requests shall be final and bindingon all persons affected by the decision, subject to the provisions for appeal of this plan.6
5. If your eligibility ends because the number of hours for which contributions are made, or requiredto be made, on your behalf by one or more contributing employers during a month, when added tothe number of hours in your Reserve Hours Account, total less than 125 Credit Hours (250 ifelecting two party or family coverage), any Credit Hours remaining in your Reserve HoursAccount shall be canceled at the end of the twelfth (12th) consecutive month during which nocontributions were made on your behalf by one or more contributing employers.6. If you are working in covered employment but become ineligible for the benefits described in thisdocument due to a change in job classification, but are eligible for Need a new name for the mainplan Construction Electricians and Construction Wiremen Trainees Plan (“CECWT Plan”)benefits and elect coverage under the CECWT Plan, the hours in your Reserve Hours Account willbe maintained, so long as you continue coverage under the CECWT Plan. If your participation inthe CECWT Plan ceases, and you become eligible for the benefits described in this document,your Reserve Hours Account will be reactivated and available to use for coverage in this Plan.TERMINATION OF YOUR COVERAGEYour coverage and that of your Dependents will end on the earliest date shown below: For hourly Active Employees, the first day of the second month following the Month in which thenumber of work hours you earn when added to the number of reserve hours in your Reserve HoursAccount does not equal at least 125 Credit Hours (250 for two party or family coverage). The first day of the month following the date on which you entered the full-time, active uniformedservice of any country, excluding service not exceeding thirty-one (31) days per year in the ReserveArmed Forces of the United States of America (but see “Self-Payment under USERRA”). The date the Plan terminates; or The date the Plan is amended to eliminate the rules which permitted eligibility to be established.In accordance with the requirements in the Affordable Care Act, the Plan will not retroactively cancelcoverage (a rescission) except when contributions and self-payments are not timely paid, or in cases whenan individual performs an act, practice or omission that constitutes fraud, or makes an intentionalmisrepresentation of material fact that is prohibited by the terms of the Plan.REINSTATEMENT OF ELIGIBILITYIf you are an Active Employee of an employer required to pay hourly contributions to the Trust, and youlose your eligibility for benefits, your coverage shall be started again on the first day of the second monththat follows a Month in which you worked at least 125 hours in covered employment. To be eligible forthis provision, you must have been covered under the Trust for at least one month out of the preceding 12months.Reinstatement of Reserve Hours Account After Military Service.If you are an Active Employee whose eligibility ends because you entered full-time active military service,you shall be entitled to use your Reserve Hours Account again if the following conditions are satisfied: the military service was in a branch of the Armed Forces of the United States of America; the military service did not exceed a term of five years; and you apply for reinstatement of the Reserve Hours Account and are available for employment byan employer under the Trust within sixty (60) days after receiving a military discharge under acondition other than dishonorable.7
Preserving Reserve Hours Account During Break In Covered Employment. Election by an Active Employee:If you are an Active Employee with 125 Credit Hours or more in your Reserve Hours Account, youmay choose to preserve the hours, rather than to use the hours for continued eligibility, during a breakin covered employment by doing the following: give written notice of this choice to the Trust within thirty (30) days after leaving coveredemployment; and within 12 months after leaving covered employment, give another written notice of your intent toreactivate the Reserve Hours Account and work 125 hours or more for which contributions arerequired to be paid to the Trust.Effective Date of Frozen Account:If the conditions of the Election by an Active Employee section above are satisfied, the Reserve HoursAccount shall be frozen on the date determined as follows: When the written notice required by paragraph (1) above is received by the Trustees on or beforethe fifteenth (15th) day of a month, the date shall be the first (1st) day of the next month; or When the written notice required by the Election by an Active Employee paragraph (1) above isreceived by the Trustees after the fifteenth (15th) day of a month, the effective date shall be thefirst (1st) day of the second month after it.Effective Date of Reinstatement:If the conditions of the Election by an Active Employee paragraph (2) above are satisfied, the ReserveHours Account of the Active Employee shall be reinstated on the first (1st) day of the second monththereafter.CONTINUATION DURING LABOR DISPUTEIf your employer is required by a Collective Bargaining Agreement to pay all or part of the cost of yourTrust contributions under the group policy and you stop work due to a labor dispute, you may continueyour insurance during the labor dispute by the rules below: This continuation will be allowed if:a. you make a payment each month for your insurance in the way an amount specified below;andb. such payments are collected from a least 75% of the employees who stop work due to the labordispute; andc. timely payment of the premiums for the insurance are made to the prepaid medical and dentalplan. You must make your monthly payments on each premium due date to the Trust.8
The amount of your monthly payment will be equal to 120% of the amount which you and youremployer would have to pay to the Trust on your behalf, if you did not stop work.This continuation will end on the earlier of: the date you start active full-time work with an employer other than the employer you stopworking for due to the labor dispute; and the last day of the sixth (6th) month that follows the date you stop working.COVERAGE DURING FAMILY AND MEDICAL LEAVEThe Family and Medical Leave Act (FMLA) allows you to take up to 12 weeks (in certain cases up to 26weeks) of unpaid leave during any 12-month period if your employer determines that your absence is dueto: The birth, adoption, or placement with you for adoption of a child. To provide care for a spouse, child or parent who is seriously ill; or For your own serious illness that makes you unable to perform your job.During the leave, you can continue your medical, dental and life/AD&D coverage offered through thePlan subject to the terms of the law. (Refer to the MetLife Certificate of Insurance for details on whenlife/AD&D coverage can be continued under an FMLA leave of absence.) You are generally eligible forleave under the FMLA if you: have worked for a covered employer for at least 12 months; have worked at least 1250 hours over the previous 12 months; and work for an employer that employs at least 50 employees within a 75-mile radius.The Plan will maintain an employee’s eligibility until the end of the leave, provided the contributingemployer properly grants the leave under the FMLA and makes payment of the required contributions tothe Plan. Call your employer to determine whether you are eligible for FMLA leave.FMLA Leave for Family of Military Service Members.Pursuant to the National Defense Authorization Act for Fiscal Year 2008, two types of leave of absenceare available to families of military personnel. During either of the following types of leave, you cancontinue your medical, dental and life coverage (but and disability benefits) offered through the Plansubject to the terms of the law. (Refer to the MetLife Certificate of Insurance for details on when life/coverage can be continued under an FMLA leave of absence.) Service Member Family Leave. An eligible employee who is the spouse, son, daughter, parent ornext of kin (i.e., nearest blood relative) of a covered service member is entitled to a total of 26 weeksof leave during a 12-month period to care for the service member. A covered service member is amember of the Armed Forces (including National Guard or Reserves) who is undergoing medicaltreatment, recuperation, or therapy (including on an outpatient basis) for a serious injury or illness.The injury or illness must have been incurred in the line of duty while on active duty, and it must bean injury or illness that may render the service member unfit to perform the duties of his/her office,grade, rank or rating. For an employee taking this new type of leave, along with FMLA for any otherpurpose (e.g., birth of a child), the combined total leave required during one 12-month period is 26weeks.9
Leave For Qualifying Exigency. An eligible employee may take up to 12 weeks of leave in one 12month period for a “qualifying exigency” (as defined in regulations issued by the Department ofLabor) arising out of the fact that the employee’s spouse, son, daughter or parent is on active duty (orhas been notified of an impending call or order to active duty) in the Armed Forces in support of acontingency operation.CONTINUATION OF COVERAGE UNDER USERRAIf you take a military leave for 30 days or less, you will continue to receive health care coverage for up to30 days, in accordance with the Uniformed Services Employment and Reemployment Rights Act of 1994(USERRA).If you take a military leave for more than 30 days, USERRA permits you to continue medical and dentalcoverage for you and your dependents at your own expense for up to 24 months, (Veterans BenefitsImprovement Act of 2004), as long as you give your employer advance notice (with exceptions) of theleave, and provided your total leave, when added to any prior periods of military leave, does not exceed 5years. Except as described in this section, your rights to self-pay under USERRA are governed bythe same conditions descried in the COBRA section of this SPD. In addition, your dependent(s) maybe eligible for health care coverage under TRICARE. This Plan will coordinate coverage with TRICARE.To qualify for continuation coverage during a period of military service, you must give your employeradvance notice of your military service, and elect and pay for continuation coverage. To be timely, youmust apply for continuation coverage by completing an election form available from the Trust Officewithin 60 days of entering uniformed service. If you elect continuation coverage, you must pay premiumsin the same amount (not to exceed 102 percent of the full premium under the Plan), form and manner asprovided under COBRA. Instead of paying for continuation coverage, you may continue coverage duringa period of military service until any reserve in your hours bank is exhausted. Coverage through the Planwill be cancelled if you depart for military service without giving advance notice to your employer, andwithout electing to continue coverage through this Plan in a timely manner.Your eligibility will be reinstated on the day you return to work or register for work with your Union oryour last employer, provided such former Employee notifies a Contributing Employer of the intent toreturn to employment within:1. Ninety (90) days from the date of discharge if the period of service was more than one hundredeighty (180) days; or2. Fourteen (14) days from th
#5729617v4/01337.017 . kern county electrical workers . construction wiremen and construction electrician . health and welfare trust . local union #428
