In most areas within the jurisdiction of the Trust Fund, you are offered a choice between the Indemnity Plan and one or more prepaid plans of medical and hospital services.

Choice of Plans:

• Indemnity Plan – Blue Cross
• Prepaid Plans – Kaiser HMO, Aetna HMO

Under the Indemnity Plan you may select any Doctor. He will be paid for his services in accordance with the Schedule of Benefits established by the Trustees of the Trust Fund. You are responsible for any difference between what the Trust Fund allows and the total charge. With the use of the hospital medical review program administered by Blue Cross Managed Care, the copayment will be even less. (The Indemnity Plan of Medical and Hospital Benefits is described in the Summary Plan Description of Benefit Programs) Under the Prepaid Health Care Plans, you must use the Doctors associated with the prepaid medical group you select. In order to determine which plan will best suit the particular health care needs of yourself and your family, please read all plans and carefully compare them before making your selection. A comparison of medical benefits of all plans, can be found in the documents/forms section on this website.

For new hires who first become eligible for Trust benefits on or after January 1, 2006, the Kaiser HMO will not be an option until a minimum of 24 months has elapsed since the individual’s initial effective date of coverage with the Fund. After the 24 month waiting period has elapsed, the Employee and his eligible Dependents may enroll in the Kaiser HMO at the next open enrollment.

Retired Employees also have a choice of Hospital-Medical Care Plans as described for Active Employees. Unless notified otherwise, the Trust Fund Administrative Office will continue the Hospital-Medical Care Plan you elected to use while covered as an Active Employee.

You should contact the Trust Fund Administrative Office if you wish to elect a different plan. Once you are covered under a Hospital-Medical Care Plan at Initial Eligibility and later wish to make a change, you must follow the same enrollment period rules that apply to Active Employees.

Unless you are enrolled in Kaiser’s Senior Advantage Program, refer to Prescription Drug Program for Active Employees and Retired Participants enrolled in the Indemnity Medical Plan. This can be found in the documents/forms section of the website by clicking Summary Plan Description on page 40.

Choice of Plans:

• Indemnity Plan – Blue Cross
• Prepaid Plans – Kaiser HMO, Aetna HMO

Please note that Retirees are eligible for benefits described in the Indemnity Hospital-Medical Care Plan. The information, benefits, exclusions and limitations under this section describing the Indemnity Hospital-Medical Care Plan apply the same for this Retiree Plan.

If you enroll in a Prepaid Health Care Plan, you will receive a brochure directly from the plan describing the benefits in detail and offering suggestions on how to best use the services of the plan. If you are enrolled in a Prepaid Health Care Plan and have not received a copy of the plan’s brochure, contact the Trust Fund Administrative Office.

If you are a non-Medicare Retiree enrolled in a Prepaid Health Care Plan, you are entitled to certain benefits pursuant to the California Mental Health Parity Act of 2001 (AB 88). AB 88 requires the provision of medically necessary and clinically appropriate mental health diagnosis and treatment of “severe mental illnesses” and “serious emotional disturbances of a child” as defined in this law. Contact Aetna or Kaiser concerning your eligibility for AB 88 benefits. Aetna- (877) 647-3776             Kaiser- (800) 464-4000

IMPORTANT: Certain services provided under the Prepaid Health Care Plans are subject to service charges. It is your responsibility to pay these service charges or any charges directly to the Prepaid Health Care Plan in which you are an enrolled participant such as Kaiser or Aetna HMO.