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Summary Plan Description Your Health and Welfare Benefits Plan Unit 190 Summary Plan Description Your Health and Welfare Benefits UNITE HERE HEALTH Summary Plan Description Alaska HERE Plan Unit 190 Effective January 1, 2020 This Summary Plan Description supersedes and replaces all materials previously issued. Dear Plan Participant: The Fund you belong to is the UNITE HERE HEALTH Fund. Our mission is to provide health benefits that offer high-quality, affordable healthcare to our participants at better value with better service than is otherwise available in the market. We believe our success depends on innovation and on engaging our participants. This book is your Summary Plan Description (SPD). It explains your Health Benefits, Life Insurance and Accidental Death and Dismemberment Plan, including information about Eligibility, benefits, limitations and exclusions, claims, claim review procedures, and your legal rights. It is your responsibility to understand your Plan of Benefits and how to use them. You can also call the Health Fund at 844-427-8501. We have representatives who can help you in both English and Spanish. These representatives are trained to answer your benefit questions and help you with your concerns. It is our pleasure to serve you, and we wish you good health! Table of Contents Using this book ..................................................................A-1 How can I get help? .............................................................. A-4 How do I get the most from my benefits? ........................A-7 Eligibility for Coverage ......................................................B-1 Termination of Coverage ...................................................B-15 Re-establishing Eligibility .................................................B-21 Prior Authorization ...........................................................C-1 Gold Medical Benefits .......................................................D-1 Silver Medical Benefits ......................................................D-17 Bronze Medical Benefits ....................................................D-33 Travel Benefit Program ......................................................D-49 Prescription Drug Benefits ................................................D-53 Coalition Health Center ....................................................D-63 Wellness and Minor Care Program .................................D-67 Dental Benefits ...................................................................D-73 Life and AD&D Insurance Benefits .................................D-81 The John Wilhelm Endowed Scholarship Benefit ...........D-89 Claim Filing and Appeal Provisions ................................E-1 Coordination of Benefits ...................................................F-1 Repayment and Subrogation .............................................F-7 Out-of-Country Emergency Claims .................................G-1 Other Important Information ..........................................H-1 General Exclusions and Limitation ..................................I-1 Your Rights under ERISA .................................................J-1 COBRA Continuation Coverage ......................................K-1 Definitions ..........................................................................K-9 UNITE HERE HEALTH Board of Trustees ...................K-21 Using this book Learn: ӹ What UNITE HERE HEALTH is. ӹ What this book is and how to use it. ӹ How your benefit options affect you. A Using this book Please take some time to review this book. If you have dependents, share this information with them, and let them know where you put this book so you and your family can use it for future reference. What is UNITE HERE HEALTH? UNITE HERE HEALTH (the Fund) was created to provide benefits for you and your covered dependents. UNITE HERE HEALTH serves participants working for Employers in the hospitality industry and is governed by a Board of Trustees made up of an equal number of Union and Employer Trustees. Each Employer contributes to the Fund based on the terms of specific Collective Bargaining Agreements (CBAs) between the Employer and the union. Your Plan, the Alaska HERE Plan, is part of UNITE HERE HEALTH. The Alaska HERE Plan has been adopted by the Trustees to pay for medical and other health and welfare benefits through the Fund. What is this book and why is it important? This book is your Summary Plan Description (SPD). Your SPD helps you understand what your benefits are and how to use your benefits. It is a summary of the Plan’s rules and regulations and describes: • What your benefits are • Limitations and exclusions • How you become Eligible for coverage • How to file claims • When your dependents are covered • How to appeal denied claims No Contributing Employer, Employer association, labor organization, or any person employed by one of these organizations has the authority to answer questions or interpret any provisions of this Summary Plan Description on behalf of the Fund. How do I use my SPD? This SPD is broken into sections. You can get more information about different topics by carefully reading each section. A summary of the topics is shown at the start of each section. When you have questions, you should always contact the Fund at 844-427-8501. The Fund can help you A-2 understand your benefits. Plan Unit 190 Using this book A Read your SPD for important information about how your benefits are paid and what rules you may need to follow. You can find more information about a specific benefit in the applicable section. For example, you can get more information about your medical benefits in the section titled “Medical Benefits”. If you want to know more about your Life and AD&D Insurance Benefit, read the section titled “Life and AD&D Insurance Benefits.” Remember, this SPD may describe benefits that do not apply to you. Your CBA determines which benefit options you have (see below). Some terms are defined for you in the section titled “Definitions” starting on page K-10. The SPD will also explain what some commonly used terms mean. When you have questions about what certain words or terms mean, contact the Fund (see page A-4). What are my benefit options? The benefits described in this SPD describe the terms of all of the benefit options available under the Alaska HERE Plan. However, your CBA determines which benefit options you have. For example, you may be Eligible to participate in the Bronze plan based on your CBA, but there is information in the SPD that explains the Gold and Silver Plan benefits, therefore, the parts of the SPD that explains the Gold and Silver Plan benefits do not apply to you. The medical benefits apply to both you and your enrolled dependents. You cannot elect coverage for your dependents only. You must elect coverage for yourself in order to elect coverage for your dependents. You can change your dependent coverage choices at certain times during the year, called “enrollment periods.” See page B-9 for more information about enrollment periods. The dental benefits apply only to you; your dependents are not Eligible for dental benefits. When you have questions about your benefits, contact the Fund at 844-427-8501. Medical benefits The Alaska Plan has a Gold Plan, Silver Plan and a Bronze Plan. Based on your CBA, you were enrolled in one of these plans, once you satisfied the initial Eligibility period. If you want to enroll your Eligible dependents in the medical benefits, you must do so during an Eligibility period. See page B-9 for more information about how to enroll your dependents. You can check your ID card or call the Fund at 844-427-8501 to see in which plan you are enrolled. See page B-3 for the amount you pay to add your dependents to the medical benefits. A-3 Plan Unit 190 A How can I get help? Other benefits The Alaska HERE Plan also includes dental benefits and life insurance and accidental death and dismemberment (AD&D) insurance benefits for employees only. These benefits are not available for Eligible dependents. You can find out more about dental benefits on Page D-74 and Life/AD&D benefits on Page D-82. UNITE HERE HEALTH 844-427-8501 Call the Fund: • When you have questions about your • To update your address. benefits. • To request new ID cards. • When you have questions about your Eligibility. • To get forms or an SPD. • When you have questions about your claim—including whether the claim has been received or paid. You can also visit UNITE HERE HEALTH’s website to get forms, get another copy of your SPD, or ask for other information: www.uhh.org. This booklet contains a summary in English of your plan rights and benefits under the Alaska HERE Plan of UNITE HERE HEALTH. If you have difficulty understanding any part of this booklet, you can call UNITE HERE HEALTH at 844-427-8501 for assistance. Phones are answered from 8:30 A.M. to 4:30 P.M. Alaska time. Other Important contacts MultiPlan CVS Caremark (888) 636-7427 (866) 818-6911 www.multiplan.com www.caremark.com Medical Rehabilitation Consultants CVS/ Caremark Specialty Pharmacy 111 W. Cataldo Avenue, Suite 200 (800) 237-2767 www.cvsspecialty.com A-4 Spokane, WA 99201-3203 (800) 827-5058 Plan Unit 190 How do I get the most from my benefits? Learn: ӹ Why you should get a primary care provider. ӹ Why you should get preventive care. ӹ How to reduce your costs for urgent care. ӹ Why you should call the Fund. ӹ How to use PPO providers to save time and money. A How do I get the most from my benefits? Get a primary care provider You and each of your dependents should have a primary care
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