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Table of Contents

Notice
Statement of Purpose
Eligibility and Enrollment
Introduction
Eligible Participants
Eligible Dependents
Enrollment Documentation
Reciprocity and "Money Follows the Carpenter"
Suspension of Eligibility For Noncovered Employment
Uniform Services Employment and Reemployment Rights Act of 1994
(USERRA)
Termination of Coverage
Benefit Portability
Family and Medical Leave Act
How the Plan Works
Introduction
Annual Deductible
Copayments
Coinsurance
Additional Out-of-Pocket Expenses
Medical Plan Maximums
Additional Plan Benefits
Benefit Summary
Preferred Provider Organization (PPO)
Introduction
ID Card
Preferred Providers
Direct Billing
Medical Review Program
Introduction
Preadmission Certification Program
Second Surgical Opinion Program
Medical Case Management Program
Medical Benefits
Ambulance Transportation
Anesthesia
Autism Spectrum Disorders
Bariatric Surgery
Blood
Chemical Dependency
Chiropractic Care
Dental Accidents
Diabetic Care
Diagnostic X-Ray and Laboratory Services
Durable Medical Equipment
Erectile Dysfunction
Hearing Aids
Home Health Care
Home Phototherapy
Hospice Care
Hospital Services and Supplies
Infusion Therapy
Kidney Dialysis
Medical Supplies
Mental Health Care
Neurodevelopmental Therapy
Neuropsychological or Psychological Assessments or Tests
Oral Surgery
Orthognathic Surgery
Orthotics
Physical Examinations
Physician Services
Pregnancy Care
Prosthetic Devices and Artificial Limbs
Reconstructive Surgery
Rehabilitative Care
Religious Nonmedical Health Care Institutions
Routine Immunizations
Screening Tests
Skilled Nursing Facility
Sleep Studies
Sterilization
Surgery
TMJ and MPDS Treatment
Tobacco Cessation Program
Transplants
Prescription Drug Benefits
Introduction
Medco Health Retail Pharmacy Program
Medco By Mail
Preferred Prescriptions Incentive Formulary
Nonparticipating Pharmacies
Limitations and Exclusions
Summary of the Prescription Drug Programs
Vision Benefits
Introduction
Schedule of Vision Care
Limitations and Exclusions
Coverage Following Termination of Eligibility
Dental Benefits
Introduction
Necessary Dental Care
Scheduled Dental Benefits
Dental Implants
Orthodontic Benefits
Time Loss Benefits
Introduction
How to File A Claim
Income Tax Withholding
Limitations and Exclusions
Reinstatement of Benefits
Life Insurance and Accidental Death and Dismemberment Benefits
Introduction
Life Insurance For Participants
Life Insurance For Dependents
Extension of Life Insurance Benefits For Total and Permanent Disability
Accidental Death and Dismemberment
Participant's Beneficiary
How to File A Claim
Purchasing An Individual Life Insurance Policy
Termination of Coverage
Retiree Health Reimbursement Accounts
Definitions
Accounts
Eligibility For Payments From Account
How to File A Claim
Claims Process
How to File A Claim
Timely Filing Requirement
Coordination of Benefits (COB) With Other Plans and Medicare
Facility of Payment
Trust's Right to Reimbursement
Right to Receive and Release Necessary Information
No Waiver of Claim Paid In Error—Recovery By Trust
Misrepresentation
Assignment
Continuation Coverage Options
Introduction
Self-Contribution Coverage
COBRA Continuation Coverage
Extension of Benefits
Carpenters Health and Security Plan—For Retired Carpenters
Glossary of Terms
General Limitations and Exclusions
Important Information
Claims and Appeals Rules
Life Insurance Claims Appeal Procedure
Rights Under the Employee Retirement Income Security Act (ERISA)
HIPAA Privacy Plan Amendment
Notice of Privacy Practices
Amendment and Termination
Benefits Not Guaranteed
Administrative Information
Names, Titles and Addresses of the Board of Trustees

 

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