Teamsters Local 170 Health and Welfare Fund

Plan General Information

Plan General Information

 

This section contains general information that you may need to know about the Plan.

Plan Name

Teamsters Local170 Health and Welfare Fund

Plan Number

The Plan Sponsor has assigned Plan Number 501 to the Plan.

Plan Employer Identification Number

The Plan’s E.I.N. is 04-2219623

Effective Date

The provisions of the SPD are effective as of January 1, 2018.

Plan Year

The Plan Year is January 1 – December 31.

Plan Sponsor

Board of Trustees
Teamsters Local 170 Health and Welfare Fund
330 Southwest Cutoff, Suite 202
Worcester, MA 01604
Telephone Number: (508)-791-3416 (800)-447-7730
Fax (508) 792-0936
E.I.N.: 04-2219623

Plan Administrator

Board of Trustees
Teamsters Local 170 Health and Welfare Fund
330 Southwest Cutoff, Suite 202
Worcester, MA 01604
Telephone Number: (508)-791-3416 (800)-447-7730
Fax (508) 792-0936
E.I.N.: 04-2219623

Service of Legal Process

The name and address of the Plan’s agent for service of legal process is:

Fund Administrator
Teamsters Local 170 Health and Welfare Fund
330 Southwest Cutoff, Suite 202
Worcester, MA 01604

Service of legal process may also be made upon the Plan Administrator.

Medical Claims Administrator

The Fund does not process or administer medical claims. The Board of Trustees has contracted with three (3) separate organizations to provide administrative services, such as claims processing, individual case management, utilization review, quality assurance programs, claim review and other related services and to arrange for a network of health care providers and/or prescription drug providers whose services are covered by this Plan. The names and addresses of the three (3) organizations can be found on the Medical Claims Administrators page.

None of these organizations serve as an insurer, but rather, serve as claims processors. Claims for benefits or services are sent to these organizations. They process the claims, then request and receive funds from the Plan to pay these claims, and they in turn, make payment to doctors, hospitals and other providers. Each of the medical administrators has sole and complete discretionary authority to determine claims and appeals in accordance with the terms of the documents or instruments governing the plan in which you are enrolled.

Type of Plan

The Plan is intended to be an “employee welfare benefit plan” within the meaning of ERISA Section 3(1). The benefits provided thereunder with the exception of Short Term Disability Income Benefit and certain Wellness Benefits are intended to be eligible for exclusion from income under the Internal Revenue Code to the extent permitted by law. The Short-Term Disability Income Benefit is intended to provide partial income replacement in the event of an employee’s disability as defined by the Plan.

Type of Administration and Funding

Teamsters Local 170 Health and Welfare Fund receives contributions from employers who have entered into collective bargaining agreements with Teamsters Local 170. Contributions are also received from eligible employees, retired employees and dependents who continue their coverage under self-payment and/or the COBRA rules of the Plan. Additionally, the Fund receives income from rent and investments.

The Fund’s assets and reserves are invested on behalf of the Fund by qualified investment managers who are authorized and approved by the Board of Trustees.

The Plan is (partially) maintained as a result of Collective Bargaining Agreements (CBAs) between Teamsters Local 170 and participating employers. You may obtain a copy of the applicable CBA upon written request to the Plan Administrator. A reasonable charge will be made for copies of the agreement. You may also examine the applicable Collective Bargaining Agreement, without charge, during regular business hours at the Fund Office.

Upon written request, the Fund will provide you with information as to whether a particular employer is contributing to the Plan on behalf of participants working under a Collective Bargaining Agreement.

Assets are held in a Trust Fund for the exclusive purpose of providing benefits to covered participants and defraying reasonable administration expenses. Some of the benefits are provided through insurance policies.

Benefits, other than life and accidental death and dismemberment benefits are paid directly from the assets of the Trust. Life and accidental death and dismemberment insurance and excess medical risk (stop-loss) coverage are purchased with premiums paid from assets of the Trust. The insurance carriers pay life and accidental death and dismemberment benefits directly to beneficiaries and reimburse the Plan when medical and pharmacy claims exceed a stated amount. Benefits are provided from Fund assets, which are accumulated under the provisions of the Trust Agreement.

Amendment and Termination

The Plan Sponsor reserves the right to amend any one or more of the underlying Plan features or Benefits at any time without the consent of or prior notice, to the extent permitted by law, to any participant. Although the Plan Sponsor expects to continue the Plan indefinitely, it is not legally bound to do so, and it reserves the right to terminate the Plan, any benefit, or any feature thereof at any time without liability. Upon the termination of the Plan, benefit, or feature, as the case may be, all elections and reductions in compensation relating to the Plan, benefit, or feature will terminate, and the rights of a participant covered under the Plan are limited to the payment of eligible expenses incurred prior to termination.