The Benefit Rate is the dollar amount (or amounts) associated with your Pension Credits which are used in calculating your monthly pension benefit under the Plan. Your Benefit Rate is used to determine the monthly amount payable to you when you retire. The Plan’s Benefit Rates are subject to change from time to time by action of the Board of Trustees, and it is possible to have more than one Benefit Rate associated with your accumulated Pension Credits.
A Contributing Employer is an employer who is required by a collective bargaining agreement or participation agreement to contribute to the Pension Fund for your hours of employment as an iron worker. If you are an Employee of a Local Union or of the Pension or Apprentice Training Funds, the Local Union or the respective Fund is your Contributing Employer.
“Coinsurance” is the percentage of Covered Medical Expenses that you must pay, in addition to applicable Deductibles and Co-Payments. The coinsurance provisions apply only in the event that you do not use the Plan’s PPO Network.
The “co-pay” is the flat amount that must be paid by you to access certain Covered Medical Expenses.
The term "Covered Employment" means employment with a Contributing Employer in a category of work covered by a Collective Bargaining Agreement or Participation Agreement under which the Contributing Employer was or is obligated to make Contributions to the Fund on behalf of its Employees. "Non-Covered Employment" means employment in the Iron Working Trade or Craft in the United States of America or Canada for an employer that is not signatory to a collective bargaining agreement (as that term is used in federal labor law) with respect to that work. "Non-Covered Employment" also means acting as an officer, director, or supervisor of, or being an owner of an interest in, such an employer, and includes any self-employment, whether as a partner, proprietor, or otherwise, in the Iron Working Trade or Craft.
The annual "Deductible" is the calendar year amount of Covered Medical Expenses which must be paid by you before Comprehensive Medical Benefits are payable by the Plan. The amount of the calendar year Deductible is shown in the SPD, and the Deductible provisions apply only in the event that you do not use the Plan’s PPO Network. A separate Deductible will apply to each covered family member up to the Family Deductible Maximum as shown in the SPD. When two or more covered family members incur Covered Medical Expenses during the same calendar year and the total Family Deductible is met, no further Deductible amounts are required for any Family Member for the remainder of the calendar year.
"Medically Necessary" means that the services, supplies, treatment and/or confinement are generally recognized in the physician's profession as effective and essential for treatment of the injury or illness for which it is ordered; and that the services are rendered at the appropriate level of care in the most appropriate setting based on diagnosis. To be considered "Medically Necessary," the care must be based on generally recognized and accepted standards of medical practice in the United States and it must be the type of care that could not have been omitted without an adverse effect on the patient's condition or the quality of medical care. In addition, services, treatment, supplies or confinement shall not be considered "Medically Necessary" if they are "Experimental", or "Investigational", or primarily limited to research in their application to the injury or illness; or if primarily for scholastic, educational, vocational or developmental training; or if primarily for the comfort, convenience or administrative ease of the provider or the patient or his or her family or caretaker.
Normal Retirement Age means the later of: (i) age 65; or (ii) the age of the Participant on the 5th Anniversary of the date he or she became a Participant in the Plan.
A charge is considered to be "Reasonable and Customary" if it is shown to be Medically Necessary and it does not exceed the prevailing level of charges being made by other service providers in the geographical area where the service was performed. In determining whether charges are Reasonable and Customary, due consideration will be given to the nature and severity of the condition being treated and any complications or unusual circumstances which require additional time, skill or experience.
“Spouse” means any individual who is: (i) lawfully married in Connecticut to a Participant under applicable Connecticut law governing marriage; or (ii) an individual in a relationship with a Participant that is recognized as a marriage under such applicable Connecticut law governing marriage. Current Connecticut law states that such an individual who is legally separated, or who is a “common law” spouse, is not lawfully married. An individual will no longer be a “Spouse” on the date that the marriage between the individual and the Participant ends either by divorce, dissolution, legal termination or separation, or annulment.
Being Vested means you have attained of Normal Retirement Age while a Participant under the Plan, or you have completed the required number of Years of Vesting Service required by Plan rules in order to be entitled to retirement benefits.