You’ve got great health and welfare benefits coverage through the North Atlantic States Carpenters Health Benefits Fund. Benefits include medical, dental, prescription drug, vision, accident and sickness coverage, life insurance and a Carpenters Assistance Program (CAP) in partnership with KGA that helps with personal and family issues not usually covered under a traditional medical plan.

The Health Benefits Fund is an employer-paid plan that provides family coverage to all members who meet semi-annual qualifying requirements. The Fund provides benefits to members from local unions within Maine, New Hampshire, Vermont, Connecticut, Rhode Island and Massachusetts.

The North Atlantic States Carpenters Health Benefits Fund knows that navigating your insurance can be confusing. To help, we hope you will take a couple of minutes to watch this video. It defines a few insurance terms that may be unfamiliar to you and explains how to best use your benefits. We want you to make informed choices that help save you and the Fund money. To view the video, click the link here: How Your Health Insurance Works

For a complete description of the comprehensive benefits package offered to eligible participants and their dependents, please visit the “Summary Plan Description”. The plan described in this document is effective January 1st, 2020, except for those provisions that specifically indicate other effective dates, and replaces all other plan documents/summary plan descriptions previously provided to you. This book provides the required information about your rights and protection under the law in order to comply with the Employee Retirement Income Security Act of 1974 (ERISA).

Eligibility

Health coverage is provided in six-month periods beginning on April 1 and October 1. To be eligible for coverage, a member must work a minimum number of hours during the qualifying periods of February– July and August–January. The hours that you are required to work may vary depending on where you work.

For information on health eligibility requirements please refer to page 47 in your “Summary Plan Description”. For hours required in order to obtain health coverage please see page 7 of the July 2018 “Special Edition Supplement”. Former 108 members who are now members of local 336 are still bound to their Eligibility code which specifies these hours.

Benefits

Medical

For information on your medical benefits, please view the “Summary Benefits Coverage for Plan 1”, “Summary Benefits Coverage for Plan 2” or Summary Benefits Coverage for “Plan 3 (Retiree Plan)”, whichever is applicable.

Vision

Davis Vision Program

The Davis Vision Program is a network of private doctors under contract to provide routine eye exams and eyeglasses. There is a select group of frames available under the Davis Vision Plan. Network doctors are located throughout New England. To find a doctor near you, call (800) 999-5431 or visit their website at www.davisvision.com.

Optional Vision Benefit

The Optional Vision Benefit allows you to see any eye doctor you choose and receive a partial reimbursement. This option is available only to members of Plan I or Plan II. Refer to page 25 in your “Summary Plan Description” for details.

Retirees and surviving spouses must call the Fund office first!

Call the Health Fund Department at 1-800-344-1515 before using your vision benefits if you are a:

  1. Retired Participant (or spouse) who is collecting a pension from the North Atlantic States Carpenters Pension, or the UBC Carpenters Pension Plan, and maintaining their union membership.
  2. A surviving spouse who is receiving the pension of a retired participant who was a union member at the time of his or her death.

Prescription Drugs

The Plan offers benefits for prescription drugs through Express Scripts at retail pharmacies and through a mail-order program.

For more information, refer to page 29 in your “Summary Plan Description”.

Dental

If you are in Plan I, you have dental coverage through Delta Dental, the nation’s largest dental network. Coverage includes routine preventive and diagnostic care at no cost to members and orthodontia benefits for children as well as adults when services are provided by a Delta Dental provider. There is no deductible to meet before the Plan begins to pay for covered services.

For more information, refer to your Dental Coverage Summary for details.

Life Insurance Benefit

The Fund provides life insurance coverage to participants who meet the Plan’s eligibility requirements and are covered under Plan 1 or Plan 2 through worked hours, including Short Hours Buy-In or a disability extension. Coverage includes lump sum benefit for your designated beneficiary in the event of your death, and a benefit for you in the event of your spouse’s death. The Fund also provides a benefit to participants who suffer a severe bodily loss in an accident.

For more information, refer to page 35 in your “Summary Plan Description” for details.

Accident and Sickness

If you become totally disabled and cannot work due to a non-work related injury or illness you may be eligible for a Weekly Accident and Sickness benefit through the North Atlantic States Carpenters Health Benefits Fund. This benefit is only available to participants in Plan 1 based on worked hours, including Short Hours Buy-In or disability extension.

If you are receiving a benefit under Workers’ Compensation, unemployment benefits, or Occupational Disease Law or similar legislation, you are not eligible for the Weekly Accident and Sickness Benefit.

Payment of Benefits

Contact the Fund Office as soon as you know you will be out of work for at least eight days to due to non-job-related disability. The Fund will advise you on filing a claim for benefits.

Once your claim is received and eligibility for a benefit confirmed, a benefit payment will begin as soon as administratively possible, retroactive to the first day of disability for a non-work-related injury, or the eighth day of disability due to an illness.

Successive periods of disability that are separated by less than two weeks of continuous active covered employment are considered one period of disability. If you suffer another disability due to a different and unrelated cause, you must return to active work for a period of more than two weeks to receive a benefit for another period of disability.

For more information, refer to page 37 in your “Summary Plan Description” for details.

Mental Health & Substance Abuse

The Fund provides certain coverage under Plan I, Plan II and the Retiree Plan for treatment of mental health and substance abuse for you and your eligible dependents.

If you need substance abuse treatment, call the Carpenters Assistance Program (CAP) first. CAP will explain the different treatment options available to you so you can make the most of what the Health Benefits Fund offers. CAP is confidential and free to participants and their families. Call (800) 344-1515, extension 1160; or contact Paul Greeley at (978) 752-1160.

In addition to CAP, the Plan offers an Employee Assistance Program through Katherine Greer Associates – KGA that provides free, confidential assistance for you and your family members when confronting stress, depression, alcoholism, drug abuse, and job or family problems. When you call, a counselor will assess your situation and set up an appointment for short-term counseling or refer you to the appropriate provider for treatment. To contact the Katherine Greer Associates – KGA Employee Assistance Program, call (800) 648-9557.

For more details on benefits under each Plan, refer to the “Summary Plan Description”.

Retiree

The Retiree Health Benefits Plan provides comprehensive medical, prescription drug and vision benefits to eligible retirees and their dependents.

Coverage is available to eligible retirees and dependents who are under age 65 and not otherwise eligible for Medicare.

The following eligibility requirements apply:

  • You retired on or after April 1, 1995 and are receiving a pension benefit from the North Atlantic States Carpenters Pension Fund or,
  • Effective October 1, 2014, you are a Shop Participant, with coverage through the New England Carpenters Brotherhood of Carpenters Labor Management Pension Fund. Union membership with your local union is required.
  • You must remain a current dues paying member in your Local Union.
  • You may not re-enroll in the Plan after coverage termination.

In addition, you must also:

  • Be eligible for five out of the past 10 insured periods through worked hours under Plan I or Plan II including Short Hour Buy-In or disability extension.
  • Be covered under Plan I or Plan II through worked hours, including Short Hour Buy-In or disability extension, in the period immediately preceding your application for retiree coverage.
  • Have no other group health insurance, including Medicare.
  • Share the cost of coverage with the Fund. Your monthly premiums will increase from time to time.

For more details in the Retiree Health Plan refer to pages 53-54 of the “Summary Plan Description”.

COBRA

Generally, you are eligible to continue your health coverage under a law known as COBRA.

The Fund also provides continued coverage in several circumstances where the individual otherwise would lose coverage and be entitled to COBRA – such as an extension of coverage due to disability or death of a participant. See the Life Events section of page 41 of your “Summary Plan Description” for more information.

Here are important things to know about COBRA:

  • You and your dependents may continue certain medical benefits under COBRA if your coverage ends due to a “qualifying event,” explained on page 62 of your “Summary Plan Description.”
  • Your children are eligible to continue coverage under COBRA when they no longer satisfy the Fund’s definition of eligible dependent because of age.
  • To keep your coverage under COBRA, you must make monthly payments to the Fund Office on time. You are fully responsible for the payment of your benefits through COBRA.

About the Marketplace

There may be other coverage options for you and your family through the Health Insurance Marketplace. In the Marketplace, you could be eligible for a tax credit that lowers your monthly premiums right away, and you can see what your premium, deductibles, and out-of-pocket costs will be before you make a decision to enroll. Being eligible for COBRA does not limit your eligibility for coverage for a tax credit through the Marketplace. Additionally, you may qualify for a special enrollment opportunity for another group health plan for which you are eligible (such as spouse’s plan), even if the plan does not accept late enrollees, if you request enrollment within 30 days.

If your coverage under the North Atlantic States Carpenters Health Benefits Fund ends due to a “qualifying event,” you and/or your covered dependents may be eligible to continue your health care coverage under the Consolidated Omnibus Budget Reconciliation Act of of 1985 (COBRA).

By making monthly payments, you and/or your dependents may continue the same medical, dental, vision and prescription drug coverage that you had before your coverage ended. Your coverage can last for up to 18, 29 or 36 months, depending on the qualifying event that resulted in your loss of coverage.

For more complete information on COBRA, including qualifying events, please visit pages 61-68 in your “Summary Plan Description”.

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