Surviving Spouse

If an employed participant dies, his or her surviving spouse and dependent children may elect to enroll in the Retired Plan if they satisfy the two eligibility requirements described below and make the required monthly contribution to the Trust Office:

• The surviving spouse and dependent children receive a monthly benefit from the Carpenters Retirement Plan of Western Washington or, for the surviving spouse and dependent children of a retired lather, from the Cement Masons and Plasterers Retirement Plan. This requirement is waived if the surviving spouse is receiving a preretirement death benefit under the Carpenters Retirement Plan of Western Washington and remarries, thereby temporarily losing his or her right to a monthly benefit.
• The participant worked at least 7,500 hours (for which employer contributions were received by the Carpenters Health and Security Trust of Western Washington) during the 120 months immediately preceding his or her death.

Employer contributions to the Carpenters Health and Security Trust of Western Washington (as described in the second bullet above) can be used to satisfy the eligibility requirements of this plan for the surviving spouse and dependent children if pension contributions were not required under a collective bargaining agreement.

The surviving spouse and dependent children are eligible effective the first of the month following the later of (1) the participant’s death, or (2) loss of eligibility under the Employed Plan. To enroll, the spouse must complete and submit to the Trust Office a Carpenters Health and Security Plan – For Retired Carpenters Application within 60 days of the later of (1) the participant’s death, or (2) the spouse’s and dependent children’s loss of eligibility under the Employed Plan.

If the surviving spouse and dependent children are eligible under the Employed Plan, they may delay enrollment in the Retired Plan by electing COBRA Continuation Coverage in lieu of the Retired Plan if they first exhaust the maximum coverage period under COBRA and complete a Notice To Decline Coverage Agreement at the time COBRA is elected (please see “COBRA Continuation Coverage” in the Employed Plan booklet).

If the surviving spouse and dependent children decline enrollment in the Retired Plan when initially eligible to enroll, they forfeit their right to enroll, unless they satisfy the special enrollment provisions described in Loss Of Other Health Care Coverage.

If the surviving spouse remarries, his or her eligibility and the eligibility of the participant’s dependent children in this plan is unaffected. However, members of the surviving spouse’s new family cannot enroll in this plan.

The surviving spouse, dependent children or beneficiary should notify the Trust Office of the participant’s death. When the Trust Office is notified, the participant’s beneficiary will receive the information necessary to submit a life insurance claim. A surviving spouse who elects to enroll in this plan must also complete a Life Insurance Beneficiary Designation – Surviving Spouse form naming a new beneficiary.

Special Enrollment Rights

A federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), allows individuals a special opportunity to enroll in the Retired Plan if enrollment was initially declined. Special enrollment rights apply in the two situations described below if certain requirements are met.

Loss Of Other Health Care Coverage

A retiree or dependents who are otherwise eligible for coverage but not enrolled may enroll for coverage if all of the following requirements are met:

• Enrollment in the Retired Plan was declined because the retiree or dependents were covered under another group health plan, other health insurance coverage or COBRA Continuation Coverage when initially eligible to enroll in the Retired Plan.
• When enrollment was declined, a Notice To Decline Coverage Agreement was completed which reserved enrollment rights for the retiree or dependents in this plan after loss of eligibility under the other group health plan, other health insurance coverage or COBRA Continuation Coverage.
• The other health care coverage terminated due to (1) loss of eligibility including loss due to legal separation, divorce, death, termination of employment or reduction in work hours; (2) termination of employer contributions; or (3) if the other coverage was under a COBRA Continuation Coverage provision, the maximum coverage period was exhausted. Loss of eligibility does not include a loss due to failure to pay apremiums on a timely basis or termination of coverage for cause, such as making a fraudulent claim or an intentional misrepresentation of a material fact in connection with the plan.

To enroll, the retiree must complete and submit to the Trust Office a Carpenters Health and Security Plan – For Retired Carpenters Application for the retiree or dependents no later than 30 days after the retiree’s or dependents’ other health care coverage terminates. Verification of continuous coverage under the other health care plan must be provided to the Trust Office with the application.

Coverage under the Retired Plan is effective the first day of the month immediately following timely receipt of the completed application. If the completed application and required documentation is not received within 30 days, the right to enroll is forfeited.

New Spouse Or Dependent Children

A retiree who is otherwise eligible for coverage but not enrolled may enroll for coverage if he or she acquires a new dependent (who is otherwise eligible for coverage) and meets one of the following requirements:

• The retiree may enroll in the Retired Plan if another individual becomes a dependent of the retiree through marriage, birth, placement for adoption, or adoption.
• The retiree and spouse may enroll in this plan if the retiree and spouse either become married or are married and have a child that becomes a dependent through birth, placement for adoption or adoption.
• The retiree and a new dependent child may enroll in this plan if the retiree’s new dependent child becomes a dependent through marriage, birth, placement for adoption, or adoption.

To enroll, the retiree must complete and submit to the Trust Office a new Enrollment Card and a Carpenters Health and Security Plan – For Retired Carpenters Application for the retiree and dependents no later than 30 days after the marriage, birth, placement for adoption, or adoption. Documentation proving dependent status must be provided to the Trust Office with the application (please see Other Enrollment Documents). In the case of marriage, coverage under the Retired Plan is effective the first day of the month immediately following timely receipt of the completed application. In the case of birth, placement for adoption or adoption, coverage under the Retired Plan is effective on the date of birth, placement for adoption or adoption.

If the completed application and required documentation is not received within 30 days, the right to enroll is forfeited.

Medicare Enrollment

Medicare is a federal health insurance program for individuals age 65 and older and certain individuals with disabilities. It is administered by the Centers For Medicare and Medicaid (CMS). Medicare is for:

• Individuals age 65 and older.
• Individuals under age 65 with certain disabilities.
• Individuals with end-stage renal disease (individuals with permanent kidney failure who need dialysis or a transplant).

There are two parts of Medicare – Part A (hospital insurance) and Part B (medical insurance). Part A is generally available at no cost. There are, however, deductible and coinsurance costs. There is a monthly premium for Part B. Part B also has an annual deductible and coinsurance costs.

Initial Enrollment Period

If an individual is not yet age 65 and already receiving Social Security Benefits or Railroad Retirement Benefits, he or she is automatically enrolled in both Medicare Part A and Part B. The individual’s Medicare effective date is the first day of the month in which he or she turns age 65. If the individual’s birthday is the first day of the month, his or her eligibility is effective the first day of the previous month.

If an individual is close to age 65 and not yet receiving Social Security Benefits or Medicare, he or she must apply for both at the same time. To insure that the Medicare Part B start date is not delayed, application should be made three months before the month the individual reaches age 65. This is the beginning of the seven month initial enrollment period. If the individual delays enrollment until age 65, or in the last three months of the initial enrollment period, his or her Part B coverage date will be delayed.

If an individual is disabled, he or she will automatically be enrolled in Medicare Part A and Part B beginning in the 25th month of disability.

General Enrollment Period

If an individual does not enroll in Medicare Part B when initially eligible, he or she can only apply during the general enrollment period, January 1 through March 31 of each year. Part B coverage then becomes effective July 1 of that year. Individuals who enroll late (generally after age 65) in Part B normally are subject to a penalty. The monthly Part B premium is increased by 10 percent for each full 12-month period that an individual was eligible for Part B but did not enroll.

Special Enrollment Period

If an individual does not enroll in Medicare Part B because the individual or the individual’s spouse was currently employed and had group health coverage through an employer or union, the individual can enroll in Medicare Part B during the special enrollment period. During the special enrollment period, an individual can enroll any time he or she is covered under the group plan. In addition, if the employment or group health coverage ends, the individual has eight months to enroll. The eight-month period starts the month after the employment ends or the group coverage ends, whichever comes first. Generally, the monthly Part B premium is not increased when enrolling for Part B during the special enrollment period. This special enrollment period also applies to disabled individuals covered under group health coverage.

Medicare Enrollment Options

An individual enrolled in Medicare Part A and Part B is automatically enrolled in the Original Medicare Plan. Other options available for individuals covered under Medicare include Individual Medicare Supplemental Insurance (Medigap) and Medicare Managed Care Plans. These options are available depending on an individual’s specific circumstances.

Original Medicare Plan

The Original Medicare Plan is a “fee-for-service” plan comprised of Medicare Part A and Part B coverage. Benefits are provided by the federal government and are available to Medicare-eligible individuals nationwide as follows:

• An individual may go to any doctor, specialist or hospital that accepts Medicare. Generally, a fee is charged each time a service is received.
• An individual pays the monthly Part B premium to Medicare.
• An individual pays an annual deductible before Medicare begins paying. After the annual deductible is satisfied, Medicare pays a certain percentage of covered services and the individual pays a certain percentage of covered services. This is known as coinsurance. After an individual receives care, he or she receives an Explanation of Medicare Benefits or a Medicare Summary Notice in the mail. These are sent by a company that processes Medicare claims. The notice lists the amount the individual may be billed by the provider.

For information on how the Retired Plan provides coverage in addition to the Original Medicare Plan, please see Coordination Of Benefits With Other Plans And Medicare.

To help cover the costs the Original Medicare Plan does not cover, an individual may do one of the following:

• Remain enrolled in the Retired Plan.
• Buy Individual Medicare Supplemental Insurance (Medigap).
• Enroll in a Medicare Managed Care Plan.

Individual Medicare Supplemental Insurance (Medigap)

Individual Medicare Supplemental Insurance (Medigap) is sold by private insurance companies to help fill the coverage “gaps” in the Original Medicare Plan. Each Medigap policy is standardized which means it must cover basic benefits. Medigap pays most, if not all, of the Original Medicare Plan’s coinsurance amounts. Medigap may also cover the Original Medicare Plan’s deductibles. Some Medigap policies cover extra benefits to fill more of the gaps in coverage, like prescription drugs. An individual must continue to pay the monthly Part B premium to Medicare and pay a monthly premium to the insurance company providing the Medigap policy.

Medicare Managed Care

A Medicare Managed Care Plan, sometimes called an HMO, is a health plan offered by private insurance companies. These plans are known as “Medicare+Choice” organizations and the plans they offer are known as “Medicare+Choice” plans. These plans are an alternative to the Original Medicare Plan. To be eligible for a Medicare Managed Care Plan, a Medicare-qualified individual must:

• Have Medicare Part A and Part B.
• Continue to pay the monthly Part B premium to Medicare. The individual may also have to pay an additional monthly premium to the Medicare+Choice organization.
• Not have end-stage renal disease (ESRD). (ESRD is permanent kidney failure that requires dialysis or a transplant.) However, ESRD beneficiaries currently in a Medicare Managed Care Plan will be able to remain in the plan they are in.
• Live in a service area where a Medicare Managed Care Plan is available. The service area is the geographic area where the plan accepts enrollees. For plans that require the individual to use their physicians and hospitals, it is also the area where services are provided. The plan may disenroll an individual if that individual moves out of the plan’s service area. If an individual is disenrolled, he or she is automatically covered under the Original Medicare Plan. An individual can also choose to join a Medicare Managed Care Plan in his or her new area, if available.

SecureHorizons

The Board of Trustees negotiated a special benefit package with reduced group rates for those Medicare-entitled retirees and spouses permanently living in the SecureHorizons service area in Washington State. The SecureHorizons Medicare Managed Care Plan for group retirees is only available to the extent that the contract between PacifiCare of Washington (SecureHorizons) and the Centers For Medicare And Medicaid (CMS) under which SecureHorizons is offered is not terminated, the SecureHorizons service area is not reduced, or the Board of Trustees continues to offer this option as an alternative to the Retired Plan. Enrollment is subject to CMS rules and regulations.

The SecureHorizons Medicare Managed Care Plan for group retirees provides benefits for services and supplies otherwise covered by Medicare, as well as prescription drugs, routine vision care, and dental care. Coverage under SecureHorizons also entitles the individual to life insurance benefits through the Retired Plan. Continuous coverage under the SecureHorizons Medicare Managed Care Plan for group retirees entitles an individual to credit toward the 12-month waiting period under the Retired Plan’s transplant benefit.

Benefits are described in a separate document that will be mailed to an individual free of charge. To enroll in SecureHorizons, please contact the Trust Office for a SecureHorizons Enrollment Kit and Application. If an individual is not eligible for Medicare at this time, he or she will be notified of this option when he or she becomes eligible for Medicare.

Prescription Drug Supplement

If a retiree or spouse elects a Medicare Managed Care Plan (other than the Secure-Horizons Medicare Managed Care Plan for group retiree described above) or Individual Medicare Supplemental Insurance (Medigap), and the plan chosen does not provide or limits prescription drug benefits, the individual may be eligible to supplement their coverage with the Prescription Drug Supplement.

The Prescription Drug Supplement provides coverage only for covered prescriptions (please see Prescription Drug Benefits) and life insurance benefits (please see Life Insurance Benefits). An individual must maintain continuous coverage under a Medicare Managed Care Plan or Individual Medicare Supplemental Insurance (Medigap) to be eligible for the Prescription Drug Supplement and to be eligible for reenrollment in the Retired Plan (please see “Disenrollment And Reenrollment In The Retired Plan” below). Coverage under the Prescription Drug Supplement does not entitle an individual to credit toward the 12-month waiting period under the Retired Plan’s transplant benefit. The plan reserves the right to terminate the Prescription Drug Supplement coverage retroactively if the retiree or the retiree’s spouse is determined to be ineligible for coverage.

To enroll in the Prescription Drug Supplement, please contact the Trust Office for a Prescription Drug Supplement Application.

Disenrollment And Reenrollment In The Retired Plan

If an individual is covered under the Retired Plan, the individual may disenroll from the Retired Plan and reenroll in the Retired Plan at a later time if the individual meets all of the following requirements:

• The individual is covered under another group health plan, a Medicare Managed Care Plan, Individual Medicare Supplemental Insurance (Medigap), or COBRA Continuation Coverage when the individual disenrolls.
• Coverage between the Retired Plan and the other group health plan, Medicare Managed Care Plan, Individual Medicare Supplemental Insurance (Medigap) or COBRA Continuation Coverage was continuous from the original date of disenrollment from the Retired Plan to reenrollment in the Retired Plan.
• The individual is otherwise eligible for coverage under the terms of the Retired Plan.

To reenroll in the Retired Plan, the retiree must complete and submit to the Trust Office a Carpenters Health and Security Plan – For Retired Carpenters Application within 30 days of loss of coverage under the other group health plan, Medicare Managed Care Plan, Individual Medicare Supplemental Insurance (Medigap), or COBRA Continuation Coverage and provide the Trust Office with a copy of the other plan’s termination of coverage notice and evidence of continuous coverage. Coverage must be reinstated the first day of the month immediately following the month coverage was terminated under the other plan, and can only be reinstated if the appropriate monthly contribution is made. There can be no gap in coverage. Coverage under the other group health plan, Medicare Managed Care Plan, Individual Medicare Supplemental Insurance (Medigap), or COBRA Continuation Coverage does not entitle an individual to credit toward the 12-month waiting period under the Retired Plan’s transplant benefit.

If an individual voluntarily leaves the Retired Plan and cannot meet all the reenrollment requirements described above, the individual forfeits his or her right to reenroll in the Retired Plan.