Retiree Health & Welfare
Health & Welfare Plan
Statement of ERISA Rights
As a Participant in the Operating Engineers Health and Welfare Fund, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA).
- Receive information about plan benefits
- Continued group health plan coverage
- Prudent actions by plan fiduciaries
- Rights in case of denial
Examine, without charge, at the Plan Administrator’s Office (the Fund Office) and at other specific locations, such as work sites and union halls, all documents governing the plan, including insurance contracts, collective bargaining agreements and a copy of the latest annual report (Form 5500 Series) filed by the Plan with the U.S. Department of Labor and available at the Public Disclosure Room of the Pension and Welfare Benefits Administration.
Obtain, upon written request to the Plan Administrator, copies of documents governing the operation of the Plan, including insurance contracts, collective bargaining agreements and a copy of the latest annual report (Form 5500 Series). The Administrator may make a reasonable charge for the copies.
Receive a summary of the Fund’s annual financial report. The Fund is required by law to furnish each Participant with a copy of this summary annual report.
Continued health care coverage for you, your Spouse or Dependents if there is a loss of coverage under the Plan as a result of a qualifying event. You or your Dependents may have to pay for such coverage. Review this summary plan description and the documents governing the plan on the rules governing your COBRA continuation coverage right.
In addition to creating rights for Plan Participants, ERISA imposes duties upon the people who are responsible for the operation of the employee benefit plan. The people who operate your Plan, called “fiduciaries” of the Plan, have a duty to do so prudently and in the interest of you and other Plan Participants and beneficiaries. No one, including your employer, your union, or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining benefits under the Plan or exercising your rights under ERISA.
If your claim for a benefit under the Plan is denied or ignored, in whole or in part, you have a right to know why this was done. You must receive a written explanation of the reason for the denial. You have the right to have the Plan (the Board of Trustees) review and reconsider your claim within certain time schedules, and a right to obtain copies of documents relating to the decision without charge.
Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of Plan documents or the latest annual report from the Plan and do not receive them within 30 days, you may file suit in federal court. In such a case, the court may require the Plan to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the Administrator.
If you have a claim for health benefits which is denied or ignored, in whole or in part, you may request a standard external review of the decision by an independent review organization (IRO) following the exhaustion of the Plan’s appeal process. External Review may also be available if your health coverage has been retroactively terminated unless the decision to terminate coverage was made because you did not meet the Plan’s eligibility rule.
You must request a standard external review within four (4) months of receipt of a notice of an adverse appeal determination made by the Board of Trustees. You also have the right to file suit in state or federal court for benefits which you claim and which were denied or ignored. In addition, if you disagree with the Plan’s decision or lack thereof concerning the qualified status of a medical child support order, you may file suit in federal court.
The Trustees’ written decision on an appeal and the IRO decision on an external review, if applicable, will be deemed to have been provided on the fifth business day following the postmark date, if mailed, or the date of delivery, if personally delivered or delivered by facsimile. A copy of this Statement of ERISA Rights, which shall constitute written notice of any applicable limitations period, shall be provided to the applicant along with the written notification of the Trustees’ decision on appeal.
If the Plan fiduciaries are misusing the Fund’s money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor or you may file suit in federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, for example, if it finds your claim frivolous.
Assistance with Your Questions
If you have any questions about your Plan, you should contact the Administrator. If you have any questions about this statement or your rights under ERISA, or if you need assistance in obtaining documents from the Plan, you should contact the nearest office of the Pension and Welfare Benefits Administration, U.S. Department of Labor listed in your telephone directory; or the Division of Technical Assistance and Inquiries, Pension and Welfare Benefits Administration:
U.S. Department of Labor
200 Constitution Avenue N.W.
Washington D.C. 20210
You may also obtain certain publications about your rights and responsibilities under ERISA by calling the Pension and Welfare Benefits Administration (866) 444-3272.