Newspaper Guild of New York • the New York Times •
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Newspaper Guild of New York • The New York Times • Guild-Times Benefits Fund Summary Plan Description for Retired Employees Age 65 or Over Effective July 1, 2006 SUMMARY PLAN DESCRIPTION FOR RETIRED EMPLOYEES AGE 65 OR OVER TABLE OF CONTENTS Newspaper Guild of New York/The New York Times Benefits Fund ..............1 Highlights of Your Benefits Fund Program for Retired Employees Age 65 or Over .......................................................3 Eligibility for Benefits ..........................................................................................5 Who is Eligible? .....................................................................................5 For Yourself ..............................................................................5 For Your Dependents ..............................................................5 Is Coverage Automatic or Must I Enroll? .............................6 What Should I Do If My Family Status Changes? ..............6 Contributions to the Cost of Coverage .............................................................7 Medical Benefits ..................................................................................................8 Before Age 65 ........................................................................................8 Age 65 or Older .....................................................................................8 Prescription Drug Program ..................................................................8 Medicare Part D .....................................................................................9 Claiming Benefits/Coordination of Benefits with Medicare ..........................11 Coverage Through A Health Maintenance Organization (HMO) ................13 When Does Your Coverage End? .....................................................................14 Continuation Of Coverage .................................................................14 Continuation Coverage Rights Under COBRA .................14 Plan Administration ..........................................................................................24 Claim Review Procedures ...................................................................24 How to Appeal ......................................................................24 Decision on Review ..............................................................25 Qualified Medical Child Support Orders ..........................................33 Reimbursement Agreement ...............................................................34 Interpreting the Plan...........................................................................36 If The Plan Ends/Changes To The Plan .............................................37 Fraud and Recovery Rule....................................................................38 Other Important Facts About The Benefits Fund .............................52 Your Rights Under ERISA .................................................................................56 NEWSPAPER GUILD OF NEW YORK • THE NEW YORK TIMES • PAGE I SUMMARY PLAN DESCRIPTION FOR RETIRED EMPLOYEES AGE 65 OR OVER NEWSPAPER GUILD OF NEW YORK - THE NEW YORK TIMES BENEFITS FUND A Summary Plan Description for Retired Employees Age 65 or Over in Guild Jurisdiction of the New York Times, WQXR, Electronic Media Company, Times Digital, Guild-Times Benefits Fund and Guild-Times Pension Fund Dear Member: The Board of Trustees of the Newspaper Guild of New York-The New York Times Benefits Fund is pleased to present you with this updated description of the health and welfare benefits for eligible retired employees in Guild jurisdiction, and their eligible dependents. A separate booklet describes the Benefits Fund program for active employees and retired employees less than age 65. The program provides financial protection and security if you or a covered dependent is ill or injured. As you look through this booklet, you will learn how you become eligible for benefits, what your benefits are and how you claim them. Since the last booklet was published, a number of changes in health care benefits have been implemented. This booklet describes the Benefit Fund’s Plan in effect as of July 1, 2006. Be sure to share this booklet with members of your family. We have tried to make it as easy to read as possible by presenting the information about your benefits in everyday language. For instance, the “Highlights of Your Benefits Fund Program for Retired Employees” section helps you see your benefits at a glance. (Of course, you should read further for details of those benefits.) The Trustees may modify or eliminate (without prior notice to you) any benefits and the eligibility requirements for benefits described in this booklet. The Trustees have the authority and discretion to interpret the plan of benefits and make final determinations regarding them. Neither employment nor benefits are guaranteed. Under no circumstances will any Plan benefits become vested or non-forfeitable with respect to active or retired employees or their beneficiaries or dependents. This booklet, called the “summary plan description” summarizes the key features of the Plan. It also constitutes the Guild-Times Benefits Fund’s plan document. Complete details of the Plan are also contained in the other official Plan documents, including the Agreement and Declaration of Trust NEWSPAPER GUILD OF NEW YORK • THE NEW YORK TIMES • PAGE 1 SUMMARY PLAN DESCRIPTION FOR RETIRED EMPLOYEES AGE 65 OR OVER that created the Fund, which legally govern the operation of the Plan. All official Plan documents are available for your inspection at the Fund Office during normal business hours, and all statements made in this booklet are subject to the provisions and terms of those documents. In case of a conflict or inconsistency between the official Plan documents and this booklet, the official documents will govern in all cases. If you have any questions about your benefits, please feel free to contact the Benefits Fund office at 212-556-3526 or fax to 212-556-3600. With our best regards, Board of Trustees Neil A. Lewis Charlotte Behrendt Barry F. Lipton Jay McKillop William O’Meara Robert Nusspickel Sam Weiss Corinne Osborn PAGE 2 • NEWSPAPER GUILD OF NEW YORK • THE NEW YORK TIMES SUMMARY PLAN DESCRIPTION FOR RETIRED EMPLOYEES AGE 65 OR OVER HIGHLIGHTS OF YOUR BENEFITS FUND PROGRAM FOR RETIRED EMPLOYEES AgE 65 OR OVER The Plan is supplemental to benefits that are provided by Medicare. Before you can participate in the Plan, Medicare must first provide you with an explanation of benefits. MEDICAL BENEFITS Hospital (per covered person each calendar year) – You elect one of the two: ß Guild-Times Benefits Fund pays the first day’s Medicare deductible, Medicare then pays the second through 21 days in full and Guild-Times Benefits Fund pays the Medicare coinsurance in full for the balance of days after the 21st day covered by Medicare (you must use your lifetime reserve); Benefits coordinated with Medicare Part A for retired employees age 65 and over ß HIP (which may be selected instead of Guild-Times Benefits Fund) (see HIP booklet for coverage information) Medical (per covered person each calendar year) ß The Guild-Times Benefits Fund administers this coverage w you pay a $300 individual deductible w the Plan pays 20% of the Medicare-approved rate w $1 million lifetime maximum per person (which includes charges incurred under the Guild-Times Benefits Fund prior to qualifying for this retirees-over-65 coverage) NEWSPAPER GUILD OF NEW YORK • THE NEW YORK TIMES • PAGE 3 SUMMARY PLAN DESCRIPTION FOR RETIRED EMPLOYEES AGE 65 OR OVER Prescription Drug Benefit ß PharmaCare provides the coverage. w There is a $100 annual deductible. w Mandatory dispensing of generic drugs if available, or retiree pays the difference. w The greater of 20% or $3 co-pay for generic, and the greater of 20% or $8 co-pay for brand. In addition, if a generic drug is available, you must also pay the price difference between the brand and generic options. w Mail order required for maintenance drugs (90 day supply at 2-½ times retail co-pay). The mail order program is mandatory after two refills of a maintenance drug. No optical, dental or life insurance benefits are provided by the Benefits Fund PAGE 4 • NEWSPAPER GUILD OF NEW YORK • THE NEW YORK TIMES SUMMARY PLAN DESCRIPTION FOR RETIRED EMPLOYEES AGE 65 OR OVER ELIGIBILITY FOR BENEFITS WHO IS ELIGIBLE? For Yourself You are eligible for health benefits from the Benefits Fund if you: 1. have retired prior to age 65 and elect to continue coverage at age 65, when you normally become eligible for Medicare benefits, or 2. retire at age 65 or older with five years of accredited service, or 3. retire due to a total and permanent disability and you are at least 40 years of age with ten years of accredited service and are eligible at the time of retirement for Medicare benefits. Retiree coverage is not available if you initially elect severance or terminate with a right to a deferred (or vested) pension. In other words, to qualify for retiree benefits, you must have been an active employee with a right to immediate pension benefits from the Guild-Times Pension Fund at the time you lost your eligibility for health benefits as an active employee. For Your Dependents The Plan offers medical benefit protection to your spouse, if your spouse is eligible for Medicare. Domestic Partners are not eligible for coverage under the Guild-Times Benefits Fund. Benefits for a retired employee less than age