This information constitutes a summary of material modification

 to your benefits as listed in your Summary Plan Description.

TOPICS

The Wellness Community

2008 Annual Update Form

New Student Verification Form

Change in Pension Beneficiary

Improved Vision Benefits

Improved Physical Therapy Benefits

Bariatric Surgery Benefits

Gardasil Immunization Coverage

Erectile Dysfunction Coverage

THE WELLNESS COMMUNITY

The mission of The Wellness Community is to help people affected by cancer enhance their health and well-being through participation in a professional program of emotional support, education, and hope. Programs and services are held in a homelike setting where people affected by cancer can come to be with others, to build support and a sense of extended family, to share, learn, and improve their quality of life.

If you are interested in the free programs and services, please refer to the Program Calendar below.

May/June 2008 Program Calendar

www.thewellnesscommunity.org

TOP                                  

2008 ANNUAL UPDATE FORMS

As stated in Section 11(A), Page 85 of the Welfare Summary Plan Description, a member is required to complete an annual  information form updating information about yourself and your eligible dependents on or before March 31, 2008.  Failure to complete this form will result in benefits not being reimbursed or a claim not being covered.

You may obtain this form by downloading one from this website or calling the Welfare office (314-739-6442) and the form will be mailed  to you.

TOP

NEW STUDENT VERIFICATION FORM

The Trust now requires completion of a Student Verification Form by the member and a school representative.  Most members should have received this form through the mail already.  If you have not, you may obtain this form by downloading one from this website or calling the Welfare office (314-739-6442) and the form will be mailed to you.

All eligibility rules for benefits are included on the top of this form.  In addition, the FAQ's page includes a section of “Frequently Asked Questions” that explains this benefit in more detail.

TOP

CHANGE IN PENSION BENEFICIARY

The Pension Office keeps completed beneficiary forms on file.  You can call or write us for a copy of your beneficiary form or you can submit a new beneficiary form.  Remember, we must pay pension benefits as indicated on your beneficiary form.  If no beneficiary form is filed or if your named beneficiary is deceased, benefits may eventually be paid to your estate or trust.

IT IS NECESSARY THAT THE MEMBER’S SIGNATURE APPEARS ON THE FORM IN THE DESIGNATED PLACES.  IN ADDITION, A WITNESS’ SIGNATURE OTHER THAN THE BENEFICIARY IS NEED TO COMPLETE THE CHANGE.

You may obtain this form by downloading one from this website or calling the Pension office (314-739-6442) and the form will be mailed to you.

TOP

TRUSTEES IMPROVE VISION BENEFITS FOR PARTICIPANTS USING VSP

The Trustees are pleased to announce improvements for those participants and dependents eligible for Vision Benefits.  The vision benefits provided by the Plan are paid out of the assets of the Plan; but the Plan has retained VSP to design the benefits and handle the claims and other administrative duties with respect to these benefits.

Regular eye examinations provide for early detection and treatment of many health conditions and/or vision loss including Diabetes, Diabetic Retinopathy, Glaucoma, Hypertension Corneal Arcus (associated with high cholesterol) and Macular Degeneration.

VSP maintains an extensive network of highly qualified private practice doctors.  If you use VSP network doctors, the doctor’s office will take care of filing any required paperwork.  In many cases, you will not have to pay anything, and in other cases, you will pay a discounted amount over the covered benefits and the total charges.  The following vision benefits restate or improve the previous benefits listed in Section 10(C), page 39 of the Summary Plan Description for Supplemental Benefits effective July 1, 2007.

 VISION BENEFIT IMPROVEMENTS

NOTE: Contact Lenses are provided in place of eyeglasses. If you or a dependent obtains contact lenses, that person will not be eligible for eyeglass lenses for 12 months and will not be eligible for eyeglass frames for 24 months.

TOP

IMPROVED BENEFITS FOR PHYSICAL THERAPY

Effective July 1, 2007, the Welfare Plan will pay expenses for physical therapy rendered on an outpatient basis up to a maximum of $2,500* for a single illness in any twelve (12) month period.  Normal co-payments and deductibles apply. 

If the Plan’s Medical Case Manager is assigned to the patient’s case and determines that additional physical therapy is medically necessary for the patient’s recovery, the Plan will pay eligible expenses up to a maximum of $5,000 for a single illness in any twelve (12) month period.  This $5,000 limit applies to all physical therapy expenses related to a single illness or injury, whether the expenses were incurred before or after assignment of the Plan’s Medical Case Manager.  Normal co-payments and deductibles will also apply.

Please note that the amount charged for physical therapy varies significantly among providers.  Typically, a “free-standing” facility specializing in physical therapy will be more economical than receiving this service at the hospital.  Before you begin physical therapy, please call the Welfare office and the staff will provide you information about providers with the most reasonable charges.  We can help you maximize your benefit dollar should numerous therapy sessions be required in your recovery.

* $2,250 for D9A members effective January 1, 2008

TOP

NEW REQUIREMENTS AND BENEFITS FOR BARIATRIC SURGERY

Bariatric surgery is a surgical procedure for treatment of morbidly obese patients.  Morbid Obesity is defined as being 100 lbs. over your ideal body weight which would be equivalent to a body mass index of 40 or greater.  Bariatrics is the branch of medicine that deals with the causes, prevention, and treatment of obesity  A helpful web-site to learn more about this type of procedure is http://www.bariatricedge.com/. 

The Trustees have adopted the following conditions effective August 1, 2007 in order for bariatric surgery to be determined as an eligible expense:

Conditions Required For The Procedure To Be Eligible As A Covered Expense

If your bariatric surgeon recommends bariatric surgery, he or she will prepare a letter to obtain preauthorization from the Welfare Trust.  The goal of this letter is to establish the medical necessity of bariatric surgery and gain approval for the procedure.  The Welfare Trust has adopted the following minimum requirements to be met before authorizing bariatric surgery:

1. The specific type of bariatric surgery procedure has been determined to be appropriate for the treatment of morbid obesity by the Centers for Medicare & Medicaid Services; and

2. The patient is greater than one hundred (100) pounds overweight or 100% over their ideal body weight; and

3. The patient is at least 18 years of age and has completed bone growth; and

4. The patient has a body-mass index (BMI) of at least forty (40); and

5. The patient is being treated by his or her Physician for at least one of the following complicating conditions; Diabetes, Hypertension, Cardiovascular disease, Pulmonary/Respiratory disease or Degenerative joint disease; and

6. The patient has been on a documented medically-supervised diet and exercise program for at least one (1) year immediately preceding the request for the procedure without successful weight loss; and

7. No surgical procedure will be authorized without the evaluation and approval of the Plan’s Medical Case Manager; and

8. The type of bariatric procedure must be performed by a Medicare-approved facility.

Recommendations for Patients seeking Pre-authorization of Bariatric Surgery

Keep track of every visit you make to a healthcare professional for obesity-related issues or visits to supervised weight loss programs. Make note of other weight loss attempts made through diet centers and fitness club memberships.  Keep good records, including receipts.

Payment of Charges

“If all of the above conditions are met, the Plan will pay for 60% of the charges at an approved facility and In-Network provider.  These charges are excluded from the annual out-of-pocket maximum and are subject to a lifetime maximum of $50,000, including any charges incurred as a result of complications from the procedure.  The Plan will not pay any charges incurred at an unapproved facility or Out-of-Network provider.”

TOP

GARDASIL IMMUNIZATION FOR FEMALE CHILDREN AGED 9 TO 26

Starting in September 1, 2006, the Plan was amended to pay one-half (50%) of the reasonable and customary charges for immunizations with Gardasil for covered female children aged 11 or 12.  After review and consideration, the Trustees have expanded coverage for females age 9 through 26.

Gardasil is an immunization recently approved by the Federal Drug Administration (FDA) to reduce the risk of human papillomavirus (HPV) and HPV-linked cervical cancer later in life.  Gardasil is given in three (3) injections over six (6) months at a total cost of approximately $360.00.

As with other childhood immunizations, the Plan will also pay the reasonable and customary charges for office visits necessary to provide these immunizations, with no deductibles or co-payments for these office visits.

If you have any questions concerning the coverage of Gardasil, please feel free to contact the Welfare Trust Office for more information.

TOP

ERECTILE DYSFUNCTION COVERAGE

The Trustees have adopted the following Erectile Dysfunction coverage policy effective January 1, 2008:

Prior to receiving benefits for Erectile Dysfunction, the participant must meet the following medical necessity criteria:

• Be under current treatment for at least one of the following medical conditions: diabetes, metabolic syndrome, neurological disease, kidney disease, multiple sclerosis, Parkinson's disease, hormonal disorder, atherosclerosis, heart or vascular disease, depression, morbid obesity, or
• Have sustained a traumatic pelvic or spinal cord injury, or
• Have undergone surgery or treatment for prostate, bladder or certain other cancers, or
• Be taking certain prescription medications with side effects or interactions that cause Erectile Dysfunction.

Once the above criteria are met, the Plan will cover the following treatment options:

Oral Medications - maximum of four doses per month in accordance with the Plan's formulary.

Injected or Inserted Medications - a maximum of four injections or insertions per month, only after unsuccessful use of oral medication for a sixty day period.

The Plan will not provide coverage for external devices, penile implant surgery, or vascular surgery to correct blockage of blood flow to the penis.

TOP