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OPERATING ENGINEERS
TRUST FUNDS

Facts About Your Plan

Name and Type of Administration of the Plan

The Plan is known as the Operating Engineers Health and Welfare Fund. It is a collectively bargained, jointly-trusteed, labor-management trust.

Type of Plan

The Plan is an employee welfare benefit plan maintained for the purpose of providing health benefits for participants in the Plan.

Plan Identification Numbers

The Employer Identification Number (EIN) issued by the Internal Revenue Service is 95-6034886. The Plan Number is 003.

Agent for Service of Legal Process

The name and address of the agent designated for the service of legal process is:

Joseph R. Ehrbar
Operating Engineers Funds, Inc.
100 Corson Street, Suite 100
Pasadena, CA 91103
(626) 356-1000

Legal process may also be served on a Plan Trustee.

Plan Administrator

The Board of Trustees is the Plan Administrator. This means that the Board of Trustees is responsible for seeing that information regarding the Plan is reported to government agencies and disclosed to Plan participants and beneficiaries in accordance with ERISA.

The Board of Trustees has designated the following administrative organization to perform the routine administrative functions and day-to-day business of the Plan:

Operating Engineers Funds, Inc.
100 Corson Street, Suite 100
Pasadena, CA 91103
(626) 356-1000

Board of Trustees

The Board of Trustees consists of an equal number of employer and union representatives selected by the employers and union in accordance with the provisions of the Trust Agreement. If you wish to contact the Board of Trustees, you should use the following address and phone number:

Operating Engineers Health and Welfare Fund
100 Corson Street, Suite 100
Pasadena, CA 91103
(626) 356-1000

Names, Titles and Addresses of the Trustees

As of the printing of this booklet, the Trustees of the Fund are:

Union Trustees Employer Trustees
Ronald J. Sikorski
Larry Davison
David Garbarino
Shawn Kinsey
David Sikorski
Carl Mendenhall
Perry Hawkins
Mike Roddy
Jim Ryan
Michael Crawford
Stanley Howard
Patrick Velasquez
Jaimie Angus
Charles Chapman

Collective Bargaining Agreements

The Plan was established, and is maintained, through collective bargaining agreements between the International Union of Operating Engineers, Local Union No 12, and participating employers.

Contributions to this Plan are made on behalf of each Participant in accordance with these collective bargaining agreements.

The Fund Office will provide you, upon written request, a copy of any of the collective bargaining agreements. The collective bargaining agreements are also available for examination at the Fund Office.

Source of Contributions

The benefits described in this booklet are provided through employer contributions to this Plan. The amount of employer contributions is determined by the provisions of the collective bargaining agreements which require contributions to this Plan at a fixed rate per hour worked. The Fund Office will provide you, upon written request, information as to whether a particular employer is contributing to this Plan on behalf of participants working under the collective bargaining agreement.

Trust Fund

The assets and reserves of the Plan are held in trust by the Board of Trustees.

Plan Amendment and Termination

The benefits provided under the Plan are not permanent. The Board of Trustees reserves the right, in its sole discretion at any time and from time to time to:

  • Terminate or amend the amount or condition of any benefits even though such termination or amendment affects claims which you may already have incurred.
  • Change or postpone the method of payment of any benefit.
  • Amend or cancel any other provision of the Plan.

The Trustees do not promise to continue the benefits and coverages in full or in part in the future, and rights to future benefits and coverages are not vested. This means they can be taken away. In particular, retirement or the completion of the requirements to receive a pension benefit under the Operating Engineers Pension Plan does not give any Participant or former Participant any vested right to continued benefits or coverages under the Operating Engineers Health and Welfare Fund.

The Board of Trustees is authorized and empowered to:

  • Decide the meaning of any doubtful or ambiguous provision of the Rules and Regulations of the Plan.
  • Decide on a Participant’s entitlement to or application for benefits under the Rules and Regulations of the Plan.
  • Sign agreements, write and carry out reasonable Rules and Regulations, and do all things necessary in the establishment, maintenance and administration of the Plan.

If the Plan terminates, any and all money and assets remaining in the Fund, after payment of expenses, will be used to continue the benefits provided by the Plan, until such money and assets have been used up.

Funding

Benefits of the Plan are provided under service agreements or insurance contracts or directly from the Fund’s assets, which are accumulated under the provisions of the collective bargaining agreements and the trust agreement, and are held in trust for the purpose of providing benefits to covered Participants and defraying reasonable operating costs.

  • PPO hospital, PPO medical, prescription drug, hearing aid, dental, vision, life and accidental death and dismemberment and weekly disability income benefits are paid directly from Fund assets.
  • Prepaid medical and prescription drug benefits are provided through Kaiser, Anthem Blue Cross, Health Plan of Nevada, United HealthCare, and OptumRx.
  • Prepaid dental benefits are provided through United Concordia, Delta Dental and MetLife.

Organizations Through Which Benefits Are Provided

The carriers listed below provide fully insured benefits under the Plan.

Prepaid Dental Benefits
Delta Dental
12898 Towne Center Drive
Cerritos, CA 90703
MetLife Dental
505 N. Euclid St., Suite 200
Anaheim, CA 92803
United Concordia Dental Plan of California
PO Box 10194
Van Nuys, CA 91420

 

Prepaid Medical and Prescription Drug Benefits
Anthem Blue Cross
21281 Burbank Blvd
Woodland Hills, CA 91367
Health Plan of Nevada
PO Box 15645
Las Vegas, NV 89114
Kaiser Permanente
393 E. Walnut St.
Pasadena, CA 91188
UnitedHealthcare
9900 Bren Road East
Minnetonka, MN 55434

The Plan is fully self-insured for the benefits obtained through the companies listed below. These companies administer at least a portion of the benefits for the Plan, but do not insure or otherwise guarantee any of the benefits of the Plan.

Company Benefits
Anthem Blue Cross
PO Box 60007
Los Angeles, CA 90060-0007
Provides access to its network of hospital and medical providers, performs healthcare management services, provider credentialing and claims screening.
OptumRx
P. O. Box 29044
Hot Springs, AR 71903
Administers the prescription drug benefit.
Vision Service Plan of America
100 Howe Ave.
Sacramento, CA 95825
Administers the vision benefit and provides access to its network of vision providers.
MHN
2370 Kerner Blvd.
San Rafael, CA 94901
Administers the Member Assistance Program, mental health and substance abuse benefits.

Individual conversion policies are provided by Kaiser Permanente, Anthem Blue Cross and Health Plan of Nevada (hospital, medical and prescription drug coverage).

All benefit types provided by the Plan are set forth in this summary plan description. The complete terms of the Vision Care Benefits are set forth in the Agreements with Vision Service Plan.

The complete terms of the prepaid benefits are set forth in the following:

  • Kaiser Permanente Group Hospital and Medical Service Agreement
  • Anthem Blue Cross Group Hospital and Professional Service Agreement
  • Health Plan of Nevada Service Agreement
  • Delta Dental Plans Service Agreement
  • MetLife Dental Services Agreement
  • United Concordia Service Agreement.

The complete terms of the self-funded benefits are set forth in the Rules and Regulations which are available to any participant at any time.

Fiscal Plan Year

The fiscal records of the Plan are kept separately for each fiscal Plan Year. The fiscal Plan Year begins on July 1 and ends on June 30.

The Plan’s Requirements with Respect to Eligibility for Participation and Benefits

For Eligibility Requirements, refer to Eligibility.

Circumstances Resulting in Disqualification, Ineligibility or Denial or Loss of Benefits

Loss of eligibility is described throughout this booklet. For additional information please contact the Fund’s Member Services department at: (866) 400-5200.

Procedures to Follow for Filing a Claim

The procedure to be followed in filing a claim for benefits is outlined in Filing a Claim for Benefits.

Claims submitted must be accompanied by any information or proof requested and reasonably required to process such claims by the Fund Office or the Board of Trustees.

Review Procedure

If your claim is denied, in whole or in part, you will receive a written explanation giving detailed reasons for the denial, specific reference to the Plan provisions on which the denial is based, a description of any additional material or information necessary for you to perfect the claim and any explanation of why such information or material is necessary, as well as an explanation of the Plan’s claim Appeals Procedure.

Revised 12/2019

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