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The answers to frequently asked questions below are general in nature and do not modify the terms of their respective Plans. You should refer to the related Summary Plan Description for more specific information regarding each Fund's Plan.
Does Plan C4 meet the minimum value standards of the ACA?
Yes, Plan C4 is a high deductible plan that provides minimum value coverage in accordance with the ACA. C4 benefits include hospital, medical/surgical, and prescription drugs (all essential benefits). In addition, all required well care services are included with no cost sharing, and the out-of-pocket limit (this will be described in more detail later in this memorandum) meets the ACA’s requirements.
How are Contributions to Plan C determined?
The Collective Bargaining Agreements describe the employer contribution rate for each unit (day, week, month, or hour) of your covered employment. Some agreements require employer contributions on a percentage of your wages.
What is the cost of C4 and how does it compare to C3?
The current quarterly cost for single coverage is $1,019.00. The quarterly cost for a family plan is currently $1,854.00. These costs are approximately 20% less than the current C3 cost. CAPP charges may change so please check with the Fund Office for current CAPP charges.
Do Plan C employer contributions accumulate in my own account?
Yes, except for the first $150 of employer contributions when you begin to work under a Plan C Collective Bargaining Agreement. Thereafter, contributions made by your employer when you work in covered employment go into your CAPP (Contributions Available for Premium Payments) account. Your CAPP account is central to your eligibility and serves as the payment mechanism for your Plan C benefits.
What is the open enrollment filing/payment deadline?
All open enrollment election coupons and any applicable co-payment, must be received at the Fund Office Lockbox no later than December 15th (or the next business day if it falls on a weekend) preceding the January 1st coverage quarter.
Is more than one plan of benefits available under Plan C?
Yes, Plan C currently hosts five (5) different coverage options plus Triple S for our Puerto Rico residents. Eligible participants can choose from C1, C2, C3, C4 or the stand alone Medical Reimbursement options. All offerings are made with a single (participant only) or family (2 or more eligible family members) rate. Our Benefits at a Glance provides a side-by-side description of each option.
Can I downgrade to C4 in the same year that I previously chose a higher level option?
Yes, each quarter the Fund Office sends a statement showing a participant’s available CAPP balance in advance of the prospective coverage quarter. Downgrading to a lower level coverage in Plan C is always permissible for a future coverage quarter. However, a participant cannot switch to a higher level of coverage except at each annual open enrollment unless there is a life event such as the birth of a child, adoption of a child, marriage or divorce. Please review the Plan’s Summary Plan Description booklet further for a description of such life events.
What is the earliest I can enroll in Plan C coverage?
New employees who have never participated in Plan C before may voluntarily enroll in Plan C once their CAPP account has enough employer contributions to meet the charge for one month of Plan C-2 individual coverage. Please note that this is after the first $150 of employer contributions for new employees is applied to the Health and Welfare Fund’s general assets.
How much is the annuity benefit?
The amount of your annuity benefit is based on the amount in your individual account when you are eligible for a benefit based on contributions received, investment earnings or losses and applicable administrative fees.
Are there separate CAPP account charges for individual and family coverages?
Yes, since Plan C coverage is financed by your individual CAPP account, the charge for family enrollment is greater than for individual enrollment.