We are pleased to provide you with this Summary Plan Description (“SPD”) summarizing the Teamsters Local 170 Health and Welfare Fund Plan (the “Plan”) sponsored by Teamsters Local 170 Health and Welfare Fund for eligible members and their eligible dependents.
The Plan is composed of the following benefits:
Tier 1 Benefit – Fallon Select Care Supreme
Tier 2 Benefit – Fallon Direct Care Premium Value
Tier 2 Benefit – Fallon Select Care Premium Value
Tier 1 Benefit – Blue Choice New England Plan 2
Tier 1 Benefit – Blue Care Elect Preferred PPO
Tier 2 Benefit – Network Blue New England Options
Retiree Dental Benefit – BCBSMA Dental Blue Freedom
Vision Benefit – Davis Vision
Attachment #10 and #11
Active Employee Life and AD& D Benefit – Hartford Life and Accident Insurance Company
This document, together with Attachments #1-11, and their respective policies, descriptions, riders and other materials (either written or electronic), constitute the summary plan description to the extent required by Section 102 of the Employee Retirement Income Security Act of 1974 (ERISA) and U.S. Department of Labor Regulation Sections 2520.102-2 and 2520.102-3 for the Plan.
This document is intended to complement the booklets provided by Blue Cross Blue Shield of MA, Fallon Health Plan, Davis Vision and The Hartford Life and Accident Insurance Company in order to create a Summary Plan Description for purposes of ERISA. The policies, contracts or booklets for each underlying Benefit feature govern the benefits to be provided and include more details on how the Benefit features operate. If there is any conflict between this document and such policies, contracts or booklets, then such other documents will control unless otherwise required by law. Participants and dependents should not rely on any oral description of the Plan because the written terms of the Plan will always govern.