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PAINTERS DISTRICT COUNCIL NO. 4HEALTH & WELFARE FUNDSUMMARY PLAN DESCRIPTIONEffective December 1, 2014
PAINTERS DISTRICT COUNCIL NO. 4 HEALTH & WELFARE FUNDSUMMARY PLAN DESCRIPTIONIntroductionThe Board of Trustees of the Painters District Council No. 4 Health & Welfare Fund ispleased to present this revised Summary Plan Description, which describes the benefits andeligibility requirements of the Welfare Plan. Also included in this booklet are the proceduresthat you should follow when filing a claim, and certain information concerning theadministration of the Plan as required by the Employee Retirement Income Security Act of 1974(ERISA).The benefits described in this booklet are the result of continuous efforts of the Board ofTrustees to offer an excellent program of benefits that will help meet the needs of your entirefamily. We urge you to read this booklet carefully so that you understand the complete packageof benefits available to you and your eligible family members. You should share this bookletwith your family and keep it in a convenient place for future reference.The Welfare Plan is designed to help you and your family to meet the continuing risingcosts of medical care as well as provide a measure of protection if you are unable to work due tolayoff or disability.This booklet summarizes the key features of your Welfare Fund benefits program.Complete details of the program are also contained in the other official Plan documents,including the Trust Agreement, the Fund’s contracts with its benefit insurers and healthmaintenance organizations, and collective bargaining agreements, which legally govern theoperation of the program. All official Plan documents are available for your inspection at theFund Office during normal business hours. All statements made in this booklet are subject to theprovisions and terms of those documents. In case of a conflict or inconsistency between theofficial Plan documents and this booklet, the official documents will govern in all cases.This booklet is not a contract of employment – it neither guarantees employment orcontinued employment with your employer or any Contributing Employer, nor diminishes in anyway the right of Contributing Employers to terminate the employment of any employee.If you have question about the plan or how to apply for benefits, do not hesitate to contactthe Fund Office.Sincerely,Board of Trustees
IDEFINITIONSCertain terms used in this Summary Plan Description have special meanings. Theseterms will be capitalized and will have the meaning set forth below:1.1Certificate of Coverage. The term “Certificate of Coverage” will mean thedocument provided to you by the insurance company or HMO chosen by the Trustees to providehealth and hospitalization coverage. Its purpose is to explain the provisions of the GroupContract.1.2Change in Family Status. The term “Change in Family Status” will meanyour marriage or divorce, the death of your spouse, the termination of employment of yourspouse, or such other change in your spouse’s employment status that results in a termination orsignificant reduction in your health care benefits.1.3amended.Code.The term “Code” will mean the Internal Revenue Code of 1986, as1.4Collective Bargaining Agreement. The term “Collective Bargaining Agreement”will mean any agreement between the Union and an Employer, which agreement requires thepayment of periodic contributions to the Fund or other written participation or other agreementacceptable to the Trustees, which agreement requires the payment of periodic contributions to theFund.1.5Group Contract. The term “Group Contract” will mean the insurance contractused by the Trustees to provide health and hospitalization coverage benefits.1.6Contributions. The term “Contributions” will mean those payments made to theFund as required by the Collective Bargaining Agreement reduced by the hourly administrativefee as established by the Trustees. Presently, the administrative fee is five per cent of thepayments required by the Collective Bargaining Agreement.1.7Covered Employment. The term “Covered Employment” will mean employmentof a type covered by a Collective Bargaining Agreement and requiring contributions to the Fund.1.8Dependent. The term “Dependent” means your spouse and each of your childrenunder age 26, including legally adopted children and children placed with you for adoption to theextent required by law. Coverage for adopted children and children placed with your foradoption shall be provided on the same basis as coverage for your natural children. This Planwill also provide benefits pursuant to the terms of any “Qualified Medical Child Support Order,”as defined in Section 609 of ERISA (including a National Medical Child Support Notice), as aresult of any domestic relations matter.1.9Disability. The term “Disability” will mean a physical or mental conditionresulting from bodily injury, disease or mental condition which renders a person incapable ofcontinuing any gainful occupation and which entitles him to benefits under the New York State11663755v2
Disability Benefits Law or Worker’s Compensation Act. Disability shall be determined by theTrustees in their sole and absolute discretion.1.10 Employee. The term “Employee” will mean any person employed by anEmployer and covered by a Collective Bargaining Agreement.1.11 Employer. The term “Employer” will mean (i) any one of the employer membersof an employer association that enters into a Collective Bargaining Agreement with the Union;(ii) an independent signatory to a Collective Bargaining Agreement that is acceptable to theBoard of Trustees; (iii) the Painters District Council No. 4 Security Benefit Fund; and (iv) theUnion.1.12 Fund. The term “Fund” will mean the Painters District Council No. 4 Health &Welfare Fund, which includes all contributions to the Trustees pursuant to the terms set forth inthe Collective Bargaining Agreement, together with all the income, earnings and profits thereonreceived by the Trustees, less any expenses paid therefrom. The Fund may be used only for thepurposes set forth in the Trust Agreement.1.13 Fund Administrator. The term “Fund Administrator” will mean the persondesignated by the Trustees to handle certain of their day-to-day administrative duties.1.14 Hour of Service. The term “Hour of Service” will mean each hour for which youare entitled to payment by the Employer and for which the Employer makes Contributions to theFund pursuant to its obligation under the Collective Bargaining Agreement.1.15 Minimum Balance. The term “Minimum Balance” will mean the minimumamount that must be in an individual’s Health Care Account in order to be eligible for benefits.The Minimum Balance is an amount equal to six months of Monthly Premium for the lowest costsingle coverage available under the Plan.1.16 Monthly Premium. The term “Monthly Premium,” will mean the amountdetermined by the Trustees to be the cost of a month of coverage for insured health benefitsprovided under the Plan.1.17 Plan. The term “Plan” will mean the written plan of benefits of the Fund adoptedby the Trustees setting forth the eligibility rules for the health and welfare benefits to be paidfrom the Fund.1.18 Plan Administrator. The term “Plan Administrator” will mean the Board ofTrustees of the Fund. The Plan Administrator will administer the Plan, keep the Plan’s recordsand has discretionary authority to construe the terms of the Plan and make determinations onquestions which affect eligibility of benefits.1.19 Plan Year. The term “Plan Year” will mean the twelve month period beginningon June 1 and continuing to the following May 31.21663755v2
1.20 Retirees. The term “Retirees” will mean the persons who have retired from thebargaining unit of Employees covered by the Collective Bargaining Agreement and are receivinga pension from the International Brotherhood of Painters and Allied Trades Pension Fund.1.21 Trust Agreement. The term “Trust Agreement” will mean the Agreement andDeclaration of Trust, Painters District Council No. 4 Health & Welfare Fund, dated December10, 1991, together with any amendments made thereto.1.22Trustees. The term “Trustees” will mean the Board of Trustees of the Fund.1.23 Union. The term “Union” will mean District Council No. 4 of Buffalo andVicinity, International Union of Painters and Allied Trades of America, AFL-CIO, and itssuccessors and assigns.IIGENERAL INFORMATION ABOUT THE FUNDThis Section contains certain general information which you may need to know about theFund.A.General Fund InformationThe name of the Fund is the Painters District Council No. 4 Health & Welfare Fund.The provisions of the Plan became effective on June 1, 1995, which is called theEffective Date of the Plan.The Fund’s records are maintained on a twelve-month period of time. This is known asthe Plan Year. The Plan Year is the twelve-month period beginning June 1 and ending thefollowing May 31.B.Plan AdministratorThe Plan is sponsored by the Board of Trustees of the Painters District Council No. 4Health & Welfare Fund. The Board of Trustees is also the Plan Administrator. The Board ofTrustees is responsible for the overall operation and administration of the Fund.The employer identification number of the Plan Sponsor is 16-6070541. The Trusteeshave assigned plan number 501 to the Fund.The following individuals currently comprise the Board of Trustees:31663755v2
Employer Trustees:Union Trustees:Joseph KnarrMadar Construction970 Bullis RoadElma, NY 14059Mark StevensDistrict Council #4585 Aero DriveCheektowaga, NY 14225John O’HareHuber Construction136 Taylor DriveDepew, NY 14043Jeffrey CarrollGlaziers LU 660585 Aero DriveCheektowaga, NY 14225Jeffrey D. SturtzA.R. Pierrepont Company154 Berkeley StreetRochester, NY 14607John LignosAmstar of WNY825 Rein RoadCheektowaga, NY 14225James CreightonLocal 15049 Navarre RoadRochester, NY 14621Robert SinopoliIUPAT Local 67739 Saginaw Drive, Ste. 16Rochester, NY 14623Responsibility for administration of health and hospital insurance claims has beendelegated to the insurance company or health maintenance organization providing those benefits.Responsibility for administration of life insurance claims has been delegated to the insurancecompany providing that benefit.Please remember that no one except the Board of Trustees (and other Plan fiduciaries andindividuals to whom the Board of Trustees has delegated responsibility for administration of thePlan) has the authority to interpret the Plan, including this booklet or the other official Plandocuments, to make any promises to you about it, or to change the provisions of the Plan. TheBoard of Trustees (or its duly authorized designee) has the exclusive right and power, in its soleand absolute discretion, to interpret the Plan documents and to decide all matters under the Plan,including, without limitation, the right to make all decisions with respect to eligibility for and theamount of benefits payable under the Plan and the right to resolve any possible ambiguities,inconsistencies or omissions concerning the Fund or the Plan. All determinations by the Boardof Trustees (or its duly authorized designee) are final and binding on all persons and will begiven full force and effect.41663755v2
C.Fund Administrator InformationThe Trustees have delegated certain day-to-day administrative duties to the FundAdministrator. The name and address of the current Fund Administrator is:Ms. Cynthia WebsterPainters District Council No. 4Health & Welfare Fund585 Aero DriveCheektowaga, NY 14225The Fund Administrator also keeps the records for the Fund. The Board of Trustees hasauthorized the Fund Administrator to respond in writing to any questions you may have aboutthe Fund. As a courtesy, the Fund Administrator may respond informally to your oral questions.However, oral questions and answers are not binding upon the Board of Trustees and cannot berelied upon in a dispute concerning your benefits. If you have an important question, you shouldcontact the Fund Administrator for a written response.D.Service of Legal ProcessThe name and address of the Fund’s agent for service of legal process is:Board of TrusteesPainters District Council No. 4Health & Welfare Fund585 Aero DriveCheektowaga, NY 14225Legal process may be served on the Plan Administrator or any individual Trustee.E.Type of PlanThe Plan is a welfare benefit plan providing health, hospitalization, health carereimbursement, supplemental unemployment, life insurance, disability, education, and vacationbenefits. The health, hospitalization and life insurance benefits are insured through insurers orhealth maintenance organizations. Other benefits are provided on a self-insured basis.The Plan is maintained pursuant to one or more collective bargaining agreements. Acopy of any such agreement may be obtained by participants and beneficiaries upon writtenrequest to the Plan Administrator, and is available for examination by participants andbeneficiaries.In addition, participants and beneficiaries may receive from the PlanAdministrator, upon written request, information as to whether a particular Employer oremployee organization is a sponsor of the Plan and, if so, the sponsor’s address.51663755v2
IIIPERSONAL ACCOUNTSA.Tax Free vs. Taxable BenefitsFor purposes of determining your eligibility for benefits under the Plan, the PlanAdministrator will create and maintain individual accounts on your behalf. A Health CareAccount will provide you with tax-free medical benefits.A Wage Replacement Account will provide you with taxable unemployment, disability,and vacation benefits.The law prohibits the transfer of any balance in your TAX FREE accounts to yourTAXABLE accounts and vice versa.Each account will include a record of contributions received on your behalf, benefitspaid, and fees and expenses charged against the account. The maintenance of these accounts isfor record keeping purposes only. You do not have a vested right to the balance in the account orany benefit offered by the Plan; accounts are used only to determine your eligibility for benefitsand actual segregation of assets does not occur.If there is no contribution to, or distribution from your Health Care Account orWage Replacement Account for a period of twenty-four (24) consecutive months, then anybalance in those accounts will be forfeited and added to the Fund’ reserves. Further, anybalance remaining in your Health Care Account upon your death (if you are not survivedby a spouse or eligible dependents), or upon the death of the survivor of your spouse oreligible dependents, will be forfeited and added to the Fund’s reserves. Any balanceremaining in your Wage Replacement Account will be forfeited upon your death andadded to the Fund’s reserves.B.Allocation of ContributionsThe basis on which Contributions made to the Fund on your behalf will be dividedbetween your accounts will depend on the type of coverage, if any, you are receiving from theFund. Contributions will be credited to your accounts as of the first of the month following themonth they are received by the Trustees.You will automatically be enrolled in single coverage from the Fund unless you choosefamily or two-person coverage or unless you provide a written certification that you have healthcare coverage through your Spouse or parent. Until your Health Care Account reaches therequired Minimum Balance, the only benefit that you may receive is single health insurancecoverage through the Fund for yourself.61663755v2
The Minimum Balance (“MB”) will be 6 months’ of premiums for the lowest cost singlehealth insurance coverage.Thereafter, your Contributions will be allocated between Fund accounts according to thepercentages set forth in the following table:If your Health Care Account balance is:andyourcoveragefrom thePlan is:Up to MBOver MB *OutsideCoverage100% Health20% HealthSingle100% Health50% HealthTwo Person (Local 660)100% Health80% HealthFamily100% Health97% Health*** The maximum amount that may be accumulated in your Wage Replacement Account is 12,500. Once your Wage Replacement Account equals or exceeds 12,500, all Contributionsmade to the Fund on your behalf, after reduction for administrative expenses, shall be allocatedto your Health Care Account. When the balance in your Wage Replacement Account falls below 12,500, Contributions will again be allocated in accordance with the table above.**The administrative fee is 3% of employer contributions. This amount is deducted fromcontributions to your Wage Replacement Account.IVHEALTH AND RELATED BENEFITSA. Health and Hospitalization CoverageHealth and hospitalization coverage will be provided through a health maintenanceorganization (HMO) or through a Group Contract issued by an insurance company, both ofwhich shall be selected by the Plan Administrator.In order to be entitled to health and hospitalization coverage, you must satisfy thefollowing conditions:(a)You must be working in Covered Employment or have reported to theUnion as eligible to work in Covered Employment;71663755v2
(b)You must have accumulated the Minimum Balance in your account to paythe Monthly Premium to the Fund Administrator on or before the 1st dayof the month; and(c)You must complete the necessary enrollment forms as provided by theFund Administrator.On your enrollment form, you may elect to enroll your spouse and/or eligible dependentchildren. Upon enrollment and from time to time thereafter, the Fund Administrator (or anyinsurer or HMO providing coverage) may require that you present satisfactory (as determined bythe Fund Administrator, in its sole and absolute discretion) proof of the initial and/or continuingeligibility of your spouse or dependent children.If you meet all the requirements for health and hospitalization coverage other thancompletion of the necessary enrollment forms, you will be enrolled in the lowest cost singlecoverage available.Special Enrollment Rights. If you decline health and hospitalizationcoverage from the Fund for yourself or for your dependents (including your spouse) because ofother health insurance coverage, you may in the future be able to enroll yourself or yourdependents in this Plan, provided that you request enrollment within 30 days after your othercoverage ends. In addition, if you have a new dependent as a result of marriage, birth, adoption,or placement for adoption, you may be able to enroll yourself and your dependents, provided thatyou request enrollment within 30 days after the marriage, birth, adoption, or placement foradoption.A child is considered placed for adoption on the date you first become legally obligatedto provide support for the child whom you plan to adopt. If the adoption does not become final,coverage for the child will terminate as of the date you no longer have a legal obligation tosupport the child.1.Benefits. The Group Contract of the insurance company whose product isthen being used will control in defining the specific health and hospitalization benefits to whichyou and your Dependents are entitled including any deductibles, co-payments, lifetime or annualcaps, network providers, and any other conditions or limitations on benefits. You will beprovided a detailed description of your benefits directly from the insurance company and youmay obtain additional copies, free of charge, from the Fund office.2.Disability. In the event you incur a Disability, you will be entitled tocontinued health and hospitalization coverage without charge to your Health Care Account for aslong as you are disabled, but not in excess of 26 weeks for each disability, provided you meet theCredit Hours requirement set forth below for the insurance quarter in which your Disabilitybegan. You will continue to receive the same form of coverage (i.e., single or family), under thesame Group Contract or HMO, as you were receiving immediately prior to your disability.81663755v2
Eligibility QuarterInsurance Quarter
a pension from the International Brotherhood of Painters and Allied Trades Pension Fund. 1.21 Trust Agreement. The term “Trust Agreement” will mean the Agreement and Declaration of Trust, Painters District Council No. 4 Health & Welfare Fund, dated December 10, 1991,
