Wisconsin Carpenters' Health Fund will change to a new Preferred Provider (PPO) network.

Download this Document (Word doc.) October, 2003

To All Employees and Dependents:

This Notice is to inform you that Wisconsin Carpenters' Health Fund will change to a new Preferred Provider (PPO) network, effective November 1, 2003, and to inform you of Plan changes that were published in the most recent Fund newsletter:

Changes to the provisions for non-bargaining unit (NBU) and alumni employees to continue eligibility while receiving disability benefits.
Revisions to the definition of "injury" in regard to Accident and Sickness Weekly Benefits.
Specification of acceptable proof of retirement for non-bargaining unit and alumni employees.
Incorporation of language to prohibit assignment to providers.
Alignment of Plan language with administrative practice regarding continuation of coverage for dependents when an employee dies.

New Preferred Provider (PPO) Network

We are pleased to announce that Associates for Health Care, Inc. (AHC), a division of BCE Emergis, will replace Health Care Network (HCN) as your new PPO provider effective November 1, 2003. AHC has an extensive network of hospitals and physicians dedicated to promoting quality, cost-effective health care. In reviewing PPO options for the Fund, we found that AHC gives our participants access to more of the providers they are currently using and also results in greater overall savings, based on the providers that our participants utilize.

In addition to a large number of providers that were part of the HCN network, the AHC network also includes the following hospitals:

UW Hospital
Wausau Hospital
Meriter Hospital
Mercy Medical Center in Appleton
Mercy Health System in Janesville

You also will be able to access a number of hospitals through BCE Emergis' ProAmerica and Shared Savings (Up & Up) networks. These include, but are not limited to, Appleton Medical Center, St. Mary's and St. Vincent Hospitals in Green Bay, St. Nicholas in Sheboygan, and Theda Clark Regional Medical Center in Neenah. Unfortunately, neither of the La Crosse area hospitals participate in the AHC network. AHC continues to negotiate with providers in that area and we will inform you if they are successful.

We will use the ProAmerica network as our national network for services rendered outside the State of Wisconsin.

The Plan's percentage copayment of covered charges is generally 90% when you use a PPO provider and 85% when a non-participating provider is used. The new AHC network will apply to services obtained on or after November 1, 2003, so you may wish to verify whether or not the providers that you and your family members are using are part of the AHC network. The new AHC 2004 PPO Directory has not yet been printed, however, we will mail you a copy as soon as it becomes available. Until then, you can confirm whether your health care providers participate in the network by calling AHC toll-free at: 1-800-952-8661 or by visiting AHC's website at: www.ahcppo.com. On AHC's website, click on "Find a Doctor/Hospital" on the left side of the screen. At the next screen, click on the AHC icon located on the lower left and you will then be routed to a Provider Lookup screen. Immediately preceding each appointment, please call your provider directly to verify that they are still in the AHC network.

The eligibility card that you received for the coverage quarter beginning November 1, 2003, reflects the new AHC logo and information on where to send claims. Please be sure to present this eligibility card to each health care provider and inform them that AHC is your new PPO.

Eligibility for NBU & Alumni Employees While Receiving Disability Benefits Effective May 1, 2003, non-bargaining unit (NBU) and alumni employees will remain eligible each month that they are credited with 30 hours per week for each week of the month that they are receiving Accident and Sickness Weekly Benefits or are eligible and provide evidence of entitlement to benefits under any Worker's Compensation or Occupational Disease Law. Previously, disabled non-bargaining unit and alumni employees were required to have 40 hours per week paid to remain eligible.

Definition of "Injury"

The Plan defines "injury" as accidental bodily damage which requires treatment by a physician and which results in loss independently of sickness and other causes.

This definition has been clarified as of August 1, 2003. For the purposes of Accident and Sickness Weekly Benefits, only an employee's absence from work which immediately follows the date of the original injury will be considered for benefits beginning on the first day of the disability. Related symptoms and recurrent symptoms of the injury will be considered a disability caused by a sickness and will be considered for Accident and Sickness Weekly Benefits beginning on the eighth day of the disability.

Acceptable Proof of Retirement for Non-Bargaining Unit and Alumni Employees

To be considered retired and eligible to continue coverage under the Wisconsin Carpenters' Health Fund retiree plan, you must provide proof of retirement from your pension fund or be receiving Social Security retirement benefits. If such proof of retirement is not available because you are a non-bargaining unit or alumni employee, the following will be considered acceptable proof of your retirement:

If you are an owner, documentation of the change of officers filed with the state or proof of sale of the company.

- OR -

If you are an officer, documentation of the change of officers filed with the state and a letter from the company verifying the change.

- OR -

If you are an office employee who is not an owner or officer, a letter from the company verifying your retirement.

Assignment of Participant Rights to Providers Is Prohibited

Trustees amended the Plan effective August 1, 2003, to prohibit assignment of Participant or eligible Dependent rights under the Plan to a provider of services or supplies.

This means that you cannot assign to any provider your right to:

receive benefits
claim benefits in accordance with Plan procedures and/or federal law
commence legal action against the Plan, Trustees, Fund, its agents, or employees
request Plan documents or other instruments under which the Plan is established or operated
request any other information that a participant or beneficiary as defined in Section 102 of ERISA may be entitled to receive upon written request to a Plan administrator
- AND -
any and all other rights afforded an eligible person, participant, or beneficiary under the Plan, Restated Trust Agreement, federal law, and state law.

This new provision does not prohibit the claims administrator or the Trustees from mailing payment of benefits directly to a provider of services or supplies.

Continuation of Coverage for Dependents When an Employee Dies

Plan language has been amended to clarify that when an employee dies, dependent children can continue coverage under Self-Payment Option1 only if the surviving spouse is continuing such coverage. Dependent children cannot continue coverage independently of the surviving spouse, unless they are eligible for and elect COBRA continuation coverage.

Please keep this Notice in your Summary Plan Description for future reference. If you have any questions about this information, please call the Fund Office.

Yours very truly,

THE BOARD OF TRUSTEES

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