Wednesday, February 19, 2025

Your Medical Benefits 'In Brief'


The information provided on this page is a brief description of the Benefit Plans offered to participants under the Southern California Soft Drink Industry and Teamsters Health and Welfare Fund. For detailed information on the medical plan options available to you, including copay, deductible, coinsurance and out-of-pocket maximums, please log-in and download the Plan’s Summary Plan Description in the Documents/Forms section of this website.

The Southern California Soft Drink Industry and Teamsters Health and Welfare Fund provides Benefit Programs for Active Employees and their Dependents as well as two Benefit Programs for Retired Employees and their Dependents.

Hospital – Medical Care Benefits For Active Employees and Dependents

For Hospital and medical services you are offered a choice between two different types of Hospital-Medical Plans: the Indemnity Hospital-Medical Care Plan ("Indemnity Plan") and one or more Prepaid HMO Plans.

Under the Indemnity Plan, you may choose any Doctor or Hospital, who will be paid for services rendered in accordance with a schedule of allowances established by the Trustees of the Fund. You are responsible for any difference between what the Plan allows and the total charge.

Under a Prepaid HMO Plan, you must use the Doctors associated with the Prepaid HMO Plan you select. In order to determine which Plan will best suit your particular health care needs and those of your family, please read all literature describing each Plan which will be provided to you at the time of your eligibility for benefits or at open enrollment and carefully compare them before making your selection.

If you and your spouse or Registered Domestic Partner are both eligible as Employees, you may each elect either the Indemnity Plan or a Prepaid HMO Plan. Please note that except for co-payments and deductibles, the Indemnity Plan will not pay benefits for expenses covered by a Prepaid HMO Plan.

If you do not select a Hospital-MedicalPlan at the time you first become eligible, you will be automatically assigned to the Indemnity Plan. You may switch to a Prepaid HMO Plan at any time thereafter. However, once you switch to an HMO Plan any further changes will be limited by the Plan rules.


Hospital - Medical Care Benefits for Retirees and Eligible Dependents

Benefits under the Retiree Plan are limited to Hospital-Medical Care and Prescription Drug Benefits. Retirees and their Dependents are not entitled to Vision, Dental, Mental Health (E-MAP) or Death and Accidental Death and Dismemberment Benefits.

All Retirees must enroll in a Prepaid HMO Plan. The Indemnity Plan is not available to Retirees who reside within a Prepaid HMO Plan’s service area.

If you are entitled to Medicare, you must be enrolled in Medicare Part A and Part B by the time of your pension award. If entitlement to Medicare is after your pension effective date, be sure to contact the Social Security Office no later than 90 days prior to your sixty-fifth (65th) birthday. Failure to enroll in Medicare Part A and Part B in a timely fashion will result in permanent termination of your Retiree coverage.

If you are age 65 or over and are actively employed (working a minimum of 80 hours of Covered Employment each month) or if you are the spouse or Registered Domestic Partner of an active Employee who is age 65 or over, you are entitled to the same benefits from the Plan as are provided to Employees and their spouses or Registered Domestic Partners under age 65. You should still enroll in Medicare Part A and Part B as soon as you are eligible to do so.

Retirees who do not live in the service area of a Prepaid HMO Plan will be required to enroll in the Indemnity Medical Plan.