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Programa De Campamento de Estadía Anne Shore ¡Cree Recuerdos Que Duren Toda La Vida!
EL PROGRAMA DE CAMPAMENTO ANNE SHORE OFRECE LO SIGUIENTE
• Experiencia en un campamento de estadía de dos, tres o cuatro semanas durante el verano • Arte, deportes, aventura al aire libre, tecnología y campamentos tradicionales • Campamentos especializados para niños con necesidades especiales
¿POR QUÉ PRESENTAR LA SOLICITUD?
El campamento de estadía es una excelente manera para que su hijo aprenda lo siguiente: • Independencia • Responsabilidad • Nuevas habilidades y pasatiempos
¿QUIÉN PUEDE PRESENTAR LA SOLICITUD?
Sus hijos pueden ser elegibles si: • Actualmente usted trabaja para un empleador contribuye y ha sido elegible para la cobertura familiar (salario o elegibilidad de clase I) a través de su Fondo de Beneficios durante al menos un año • Ellos tienen entre 9 y 15 años de edad al comienzo del campamento
Presente la solicitud en línea antes del 31 de enero en: www.1199SEIUBenefits.org/Anne-Shore-Camp
Para obtener más información, comuníquese con la Corporación de Cuidado Infantil del Empleador de 1199SEIU al (212) 564-2220 o por correo electrónico a AnneShoreCampProgram@1199Funds.org.
If you would like a copy of the Funds’ Notice of HIPAA Privacy Practices, please visit www.1199SEIUBenefits.org, or request one in writing by writing to the 1199SEIU Benefit Funds Privacy Officer at 498 Seventh Avenue, 9th Floor, New York, NY 10018.
This is a summary of the annual report of the 1199SEIU League Job Security Fund (the “Fund”), EIN: 13-3712851, for the period January 1, 2020, to December 31, 2020. This is a welfare benefit plan offering retraining, unemployment, continued health insurance, job security and job placement benefits. The annual report has been filed with the Employee Benefits Security Administration, as required under the Employee Retirement Income Security Act of 1974 (ERISA). SUMMARY ANNUAL REPORT
This is a summary of the annual report of the 1199SEIU National Benefit Fund for Health and Human Service Employees (the “Fund”), EIN: 13-1628401, for the period January 1, 2020, to December 31, 2020. This is a welfare benefit plan offering life insurance, health, dental, vision and prescription drug benefits. The annual report has been filed with the Employee Benefits Security Administration, as required under the Employee Retirement Income Security Act of 1974 (ERISA).
Except with respect to the benefits specified under “Insurance Information” below, the plan is self-insured and has committed to pay covered claims out of plan assets.
Insurance Information
The plan has contracts with Amalgamated Life Insurance Company (“Amalgamated Life”), Guardian Life Insurance Company of America, Excellus BlueCross BlueShield (“Excellus BCBS”), Aetna Life Insurance Company, Humana Medical Plans Inc., Emblem Health and MVP Health Care to pay certain life insurance, dental benefits, and accidental death and dismemberment claims incurred under the terms of the plan. The total premiums paid for the plan year ending December 31, 2020, were $147,257,672.
Because the Amalgamated Life and Excellus BCBS contracts are so-called “experiencerated” contracts, the premium costs are affected by, among other things, the number and size of claims. Of the total insurance premiums paid for the plan year ending December 31, 2020, the premiums paid under such “experience-rated” contracts were $12,078,186, and the total of all benefit claims paid under these experience-rated contracts during the plan year was $11,737,685.
Basic Financial Statement
The value of plan assets, after subtracting liabilities of the plan, was $83,911,703 as of December 31, 2020, compared to $129,667,010 as of January 1, 2020. During the plan year, the plan experienced a decrease in its net assets of $45,755,307. This change includes unrealized appreciation and depreciation in the value of plan assets; that is, the difference between the value of the plan’s assets at the end of the year and the value of the assets at the beginning of the year, or the cost of assets acquired during the year. During the plan year, the plan had total income of $1,873,616,780, including employer contributions of $1,867,501,512, gain in earnings from investments of $531,525, COBRA payments of $2,894,811, and other earnings of $2,688,932. Plan expenses were $1,919,372,087. These expenses included $104,197,885 in administrative expenses, $1,787,453,382 in benefits paid to participants and beneficiaries, $38,345 in investment and advisor fees, $190,012 in interest expenses, $17,803,592 in lease expenses and $9,688,871 in other expenses.
Your Rights to Additional Information
You have the right to receive a copy of the full annual report, or any part thereof, on request. The items listed below are included in that report: 1. An accountant’s report; 2. Financial information and information on payments to service providers; 3. Assets held for investment; 4. Insurance information, including sales commissions paid by insurance carriers; 5. Information regarding any common or collective trusts, pooled separate accounts, master trusts or 103-12 investment entities in which the plan participates; and 6. Actuarial information regarding the funding of the plan.
To obtain a copy of the full annual report, or any part thereof, write to the Board of Trustees of the 1199SEIU National Benefit Fund for Health and Human Service Employees, who is the plan administrator, at PO Box 842, New York, NY 10108-0842, or call Member Services at (646) 473-9200.
You also have the right to receive from the plan administrator, on request and at no charge, a statement of the assets and liabilities of the plan and accompanying notes, or a statement of income and expenses of the plan and accompanying notes, or both. If you request a copy of the full annual report from the plan administrator, these two statements and accompanying notes will be included as part of that report.
You also have the legally protected right to examine the annual report at the main office of the plan at the 1199SEIU National Benefit Fund for Health and Human Service Employees, 498 Seventh Avenue, 9th Floor, New York, NY 10018, and at the U.S. Department of Labor in Washington, DC, or to obtain a copy from the U.S. Department of Labor upon payment of copying costs. Requests to the Department should be addressed to: U.S. Department of Labor, Employee Benefits Security Administration, Public Disclosure Room, 200 Constitution Avenue NW, Suite N-1515, Washington, DC 20210.
Your Rights to Additional Information
You have the right to receive a copy of the full annual report, or any part thereof, on request. The items listed below are included in that report: 1. An accountant’s report; and 2. Financial information and information on payments to service providers.
To obtain a copy of the full annual report, or any part thereof, write to the Board of Trustees of the 1199SEIU League Job Security Fund, who is the plan administrator, at PO Box 842, New York, NY 10108-0842, or call Member Services at (646) 473-9200.
You also have the right to receive from the plan administrator, on request and at no charge, a statement of the assets and liabilities of the plan and accompanying notes, or a statement of income and expenses of the plan and accompanying notes, or both. If you request a copy of the full annual report from the plan administrator, these two statements and accompanying notes will be included as part of that report.
You also have the legally protected right to examine the annual report at the main office of the plan at the 1199SEIU League Job Security Fund, 498 Seventh Avenue, 9th Floor, New York, NY 10018, and at the U.S. Department of Labor in Washington, DC, or to obtain a copy from the U.S. Department of Labor upon payment of copying costs. Requests to the Department should be addressed to: U.S. Department of Labor, Employee Benefits Security Administration, Public Disclosure Room, 200 Constitution Avenue NW, Suite N-1515, Washington, DC 20210.
Basic Financial Statement
The value of plan assets, after subtracting liabilities of the plan, was $14,785,370 as of December 31, 2020, compared to $14,883,949 as of January 1, 2020. During the plan year, the plan experienced a decrease in its net assets of $98,579. This change includes unrealized appreciation and depreciation in the value of plan assets; that is, the difference between the value of the plan’s assets at the end of the year and the value of the assets at the beginning of the year, or the cost of assets acquired during the year. During the plan year, the plan had total income of $7,275,139, including employer contributions of $7,156,662 and other earnings of $118,477. Plan expenses were $7,373,718. These expenses included $2,733,383 in administrative expenses and $4,640,335 in benefits paid to participants.
TThis is a summary of the annual report of the 1199SEIU League Registered Nurse Training and Job Security Fund (the “Fund”), EIN: 13-3946135, for the period January 1, 2020, to December 31, 2020. This is a welfare benefit plan offering educational and training benefits to participating RNs. The annual report has been filed with the Employee Benefits Security Administration, as required under the Employee Retirement Income Security Act of 1974 (ERISA).
Your Rights to Additional Information
You have the right to receive a copy of the full annual report, or any part thereof, on request. The items listed below are included in that report: 1. An accountant’s report; and 2. Financial information and information on payments to service providers.
To obtain a copy of the full annual report, or any part thereof, write to the Board of Trustees of the 1199SEIU League Registered Nurse Training and Job Security Fund, who is the plan administrator, at PO Box 842, New York, NY 10108-0842, or call Member Services at (646) 473-9200.
You also have the right to receive from the plan administrator, on request and at no charge, a statement of the assets and liabilities of the plan and accompanying notes, or a statement of income and expenses of the plan and accompanying notes, or both. If you request a copy of the full annual report from the plan administrator, these two statements and accompanying notes will be included as part of that report.
You also have the legally protected right to examine the annual report at the main office of the plan at the 1199SEIU League Registered Nurse Training and Job Security Fund, 498 Seventh Avenue, 9th Floor, New York, NY 10018, and at the U.S. Department of Labor in Washington, DC, or to obtain a copy from the U.S. Department of Labor upon payment of copying costs. Requests to the Department should be addressed to: U.S. Department of Labor, Employee Benefits Security Administration, Public Disclosure Room, 200 Constitution Avenue NW, Suite N-1515, Washington, DC 20210.
Basic Financial Statement
The value of plan assets, after subtracting liabilities of the plan, was $1,913,013 as of December 31, 2020, compared to $1,644,713 as of January 1, 2020. During the plan year, the plan experienced an increase in its net assets of $268,300. This change includes unrealized appreciation and depreciation in the value of plan assets; that is, the difference between the value of the plan’s assets at the end of the year and the value of the assets at the beginning of the year, or the cost of assets acquired during the year. During the plan year, the plan had total income of $2,903,225, including employer contributions of $2,577,052 and other earnings of $326,173. Plan expenses were $2,634,925. These expenses included $803,572 in administrative expenses and $1,831,353 in benefits paid to participants.
This is a summary of the annual report of the 1199SEIU/Employer Child Care Fund (the “Fund”), EIN: 13-3641466, for the period January 1, 2020, to December 31, 2020. This is a welfare benefit plan offering child-care benefits. The annual report has been filed with the Employee Benefits Security Administration, as required under the Employee Retirement Income Security Act of 1974 (ERISA).
Insurance Information
The plan has a contract with Metropolitan Life Insurance Company to pay certain child-care claims incurred under the terms of the plan. The total premiums paid for the plan year ending December 31, 2020, were $11,551.
Basic Financial Statement
The value of plan assets, after subtracting liabilities of the plan, was $6,801,641 as of December 31, 2020, compared to $7,936,662 as of January 1, 2020. During the plan year, the plan experienced a decrease in its net assets of $1,135,021. This change includes unrealized appreciation and depreciation in the value of plan assets; that is, the difference between the value of the plan’s assets at the end of the year and the value of the assets at the beginning of the year, or the cost of assets acquired during the year. During the plan year, the plan had total income of $27,046,609, including employer contributions of $26,884,753, program revenue of $145,695 and other earnings of $16,161. Plan expenses were $28,181,630. These expenses included $9,853,172 in administrative and indirect program expenses, and $18,328,458 in benefits paid to participants and beneficiaries.
Your Rights to Additional Information
You have the right to receive a copy of the full annual report, or any part thereof, on request. The items listed below are included in that report: 1. An accountant’s report; 2. Financial information and information on payments to service providers; 3. Assets held for investment; and 4. Insurance information, including sales commissions paid by insurance carriers.
To obtain a copy of the full annual report, or any part thereof, write to the Board of Trustees of the 1199SEIU/Employer Child Care Fund, who is the plan administrator, at PO Box 842, New York, NY 10108-0842, or call Member Services at (646) 473-9200.
You also have the right to receive from the plan administrator, on request and at no charge, a statement of the assets and liabilities of the plan and accompanying notes, or a statement of income and expenses of the plan and accompanying notes, or both. If you request a copy of the full annual report from the plan administrator, these two statements and accompanying notes will be included as part of that report.
You also have the legally protected right to examine the annual report at the main office of the plan at the 1199SEIU/Employer Child Care Fund, 498 Seventh Avenue, 9th Floor, New York, NY 10018, and at the U.S. Department of Labor in Washington, DC, or to obtain a copy from the U.S. Department of Labor upon payment of copying costs. Requests to the Department should be addressed to: U.S. Department of Labor, Employee Benefits Security Administration, Public Disclosure Room, 200 Constitution Avenue NW, Suite N-1515, Washington, DC 20210.
This is a summary of the annual report of the 1199SEIU Greater New York Benefit Fund (the “Fund”), EIN: 13-6125570, for the period January 1, 2020, to December 31, 2020. This is a welfare benefit plan offering life insurance, health, dental, vision and prescription drug benefits. The annual report has been filed with the Employee Benefits Security Administration, as required under the Employee Retirement Income Security Act of 1974 (ERISA).
Except with respect to the benefits specified under “Insurance Information” below, the plan is self-insured and has committed to pay covered claims out of plan assets.
Insurance Information
The plan has contracts with Amalgamated Life Insurance Company (“Amalgamated Life”) and Cigna Health and Life Insurance Company (“Cigna”) to pay certain life insurance and dental benefits claims incurred under the terms of the plan. The total premiums paid for the plan year ending December 31, 2020, were $1,312,005.
Because the Amalgamated Life and Cigna contracts are so-called “experience-rated” contracts, the premium costs are affected by, among other things, the number and size of claims. Of the total insurance premiums paid for the plan year ending December 31, 2020, the premiums paid under such “experience-rated” contracts were $832,336, and the total of all benefit claims paid under these experience-rated contracts during the plan year was $1,163,134.
Basic Financial Statement
The value of plan assets, after subtracting liabilities of the plan, was $50,095,606 as of December 31, 2020, compared to $92,008,488 as of January 1, 2020. During the plan year, the plan experienced a decrease in its net assets of $41,912,882. This change includes unrealized appreciation and depreciation in the value of plan assets; that is, the difference between the value of the plan’s assets at the end of the year and the value of the assets at the beginning of the year, or the cost of assets acquired during the year. During the plan year, the plan had total income of $203,398,544, including employer contributions of $199,058,117, a gain in earnings from investments of $266,874, COBRA payments of $304,760, member spousal contributions of $3,646,223 and other earnings of $122,570. Plan expenses were $245,311,426. These expenses included $14,816,175 in administrative expenses and $2,483,120 in other expenses, $227,950,708 in benefits paid to participants and beneficiaries, and $61,423 in investment and advisor fees.
Your Rights to Additional Information
You have the right to receive a copy of the full annual report, or any part thereof, on request. The items listed below are included in that report: 1. An accountant’s report; 2. Financial information and information on payments to service providers; 3. Assets held for investment; 4. Insurance information, including sales commissions paid by insurance carriers; 5. Transactions in excess of 5 percent of the plan assets; 6. Information regarding any common or collective trusts, pooled separate accounts, master trusts or 103-12 investment entities in which the plan participates; and 7. Actuarial information regarding the funding of the plan.
To obtain a copy of the full annual report, or any part thereof, write to the Board of Trustees of the 1199SEIU Greater New York Benefit Fund, who is the plan administrator, at PO Box 842, New York, NY 10108-0842, or call Member Services at (646) 473-9200.
You also have the right to receive from the plan administrator, on request and at no charge, a statement of the assets and liabilities of the plan and accompanying notes, or a statement of income and expenses of the plan and accompanying notes, or both. If you request a copy of the full annual report from the plan administrator, these two statements and accompanying notes will be included as part of that report.
You also have the legally protected right to examine the annual report at the main office of the plan at the 1199SEIU Greater New York Benefit Fund, 498 Seventh Avenue, 9th Floor, New York, NY 10018, and at the U.S. Department of Labor in Washington, DC, or to obtain a copy from the U.S. Department of Labor upon payment of copying costs. Requests to the Department should be addressed to: U.S. Department of Labor, Employee Benefits Security Administration, Public Disclosure Room, 200 Constitution Avenue NW, Suite N-1515, Washington, DC 20210.
This is a summary of the annual report of the 1199SEIU Greater New York Job Security Fund (the “Fund”), EIN: 05-0557207, for the period January 1, 2020, to December 31, 2020. This is a welfare benefit plan offering retraining, unemployment and continued health insurance benefits. The annual report has been filed with the Employee Benefits Security Administration, as required under the Employee Retirement Income Security Act of 1974 (ERISA).
Your Rights to Additional Information
You have the right to receive a copy of the full annual report, or any part thereof, on request. The items listed below are included in that report: 1. An accountant’s report; and 2. Financial information and information on payments to service providers.
To obtain a copy of the full annual report, or any part thereof, write to the Board of Trustees of the 1199SEIU Greater New York Job Security Fund, who is the plan administrator, at PO Box 842, New York, NY 10108-0842, or call Member Services at (646) 473-9200.
You also have the right to receive from the plan administrator, on request and at no charge, a statement of the assets and liabilities of the plan and accompanying notes, or a statement of income and expenses of the plan and accompanying notes, or both. If you request a copy of the full annual report from the plan administrator, these two statements and accompanying notes will be included as part of that report.
You also have the legally protected right to examine the annual report at the main office of the plan at the 1199SEIU Greater New York Job Security Fund, 498 Seventh Avenue, 9th Floor, New York, NY 10018, and at the U.S. Department of Labor in Washington, DC, or to obtain a copy from the U.S. Department of Labor upon payment of copying costs. Requests to the Department should be addressed to: U.S. Department of Labor, Employee Benefits Security Administration, Public Disclosure Room, 200 Constitution Avenue NW, Suite N-1515, Washington, DC 20210.
Basic Financial Statement
The value of plan assets, after subtracting liabilities of the plan, was $7,399,193 as of December 31, 2020, compared to $6,185,574 as of January 1, 2020. During the plan year, the plan experienced an increase in its net assets of $1,213,619. This change includes unrealized appreciation and depreciation in the value of plan assets; that is, the difference between the value of the plan’s assets at the end of the year and the value of the assets at the beginning of the year, or the cost of assets acquired during the year. During the plan year, the plan had total income of $1,665,312, including employer contributions of $1,646,504 and interest income of $18,808. Plan expenses were $451,693. These expenses included $165,895 in administrative expenses and $285,798 in benefits paid to participants.
This is a summary of the annual report of the 1199SEIU/Greater New York Child Care Fund (the “Fund”), EIN: 75-3086330, for the period January 1, 2020, to December 31, 2020. This is a welfare benefit plan offering child-care benefits. The annual report has been filed with the Employee Benefits Security Administration, as required under the Employee Retirement Income Security Act of 1974 (ERISA).
Basic Financial Statement
The value of plan assets, after subtracting liabilities of the plan, was $1,405,916 as of December 31, 2020, compared to $1,401,784 as of January 1, 2020. During the plan year, the plan experienced an increase in its net assets of $4,132. This change includes unrealized appreciation and depreciation in the value of plan assets; that is, the difference between the value of the plan’s assets at the end of the year and the value of the assets at the beginning of the year, or the cost of assets acquired during the year. During the plan year, the plan had total income of $3,377,774, including employer contributions of $3,341,223, program revenue of $36,551 and other earnings of $0. Plan expenses were $3,373,642. These expenses included $1,008,737 in administrative and indirect program expenses, and $2,364,905 in benefits paid to participants and beneficiaries.
Your Rights to Additional Information
You have the right to receive a copy of the full annual report, or any part thereof, on request. The items listed below are included in that report: 1. An accountant’s report; and 2. Financial information and information on payments to service providers.
To obtain a copy of the full annual report, or any part thereof, write to the Board of Trustees of the 1199SEIU/Greater New York Child Care Fund, who is the plan administrator, at PO Box 842, New York, NY 10108-0842, or call Member Services at (646) 473-9200.
You also have the right to receive from the plan administrator, on request and at no charge, a statement of the assets and liabilities of the plan and accompanying notes, or a statement of income and expenses of the plan and accompanying notes, or both. If you request a copy of the full annual report from the plan administrator, these two statements and accompanying notes will be included as part of that report.
You also have the legally protected right to examine the annual report at the main office of the plan at the 1199SEIU/Greater New York Child Care Fund, 498 Seventh Avenue, 9th Floor, New York, NY 10018, and at the U.S. Department of Labor in Washington, DC, or to obtain a copy from the U.S. Department of Labor upon payment of copying costs. Requests to the Department should be addressed to: U.S. Department of Labor, Employee Benefits Security Administration, Public Disclosure Room, 200 Constitution Avenue NW, Suite N-1515, Washington, DC 20210.
Discrimination Is Against the Law
The 1199SEIU Benefit Funds comply with applicable federal civil rights laws and do not discriminate against or exclude people on the basis of race, color, national origin, age, disability or sex. The Funds provide free aids and services to people with disabilities to communicate effectively with us, such as qualified sign language interpreters and written information in other formats (large print, audio, accessible electronic formats). The Funds provide free language services to people whose primary language is not English, such as qualified interpreters and information written in other languages. If you need these services, contact the Compliance Coordinator. If you believe the Funds have failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance with: Compliance Coordinator, 498 Seventh Avenue, New York, NY 10018; (646) 473-6600 (phone); (646) 473-8959 (fax); PrivacyOfficer@1199Funds.org (email). You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, the Compliance Coordinator can help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201; (800) 368-1019 or (800) 537-7697 (TDD).
Complaint forms are available at www.hhs.gov/ocr/complaints/index.html.
Language Assistance Services
This Summary of Material Modifications describes changes that affect your welfare benefit plan and updates the Summary Plan Description (“SPD”) and Summary of Benefits and Coverage (“SBC”) that was previously distributed to you. You should keep this summary with your current SPD and SBC until the booklet is updated to reflect the changes discussed herein.
Effective on or about September 9, 2021, the 1199SEIU National Benefit Fund for Health and Human Service Employees (the “Fund”) SBC and SPD and/or Plan shall be amended to provide that the Plan will cover Partial Hospitalization Programs (“PHP”) for substance abuse disorders, and to clarify its restrictions on custodial care charges and unproven procedures. The following underlined and bold language shall be added to the SPD and the strikethrough language shall be omitted:
OVERVIEW and SECTION II.C
• Benefits are not provided for care in a sub-acute nursing home or skilled nursing facility
WHAT IS NOT COVERED
The Benefit Fund does not cover: … • Care or service in a nursing home, skilled nursing facility, rest home or convalescent home • Custodial care or sub-acute care in a hospital, skilled nursing facility, nursing home, or any other institution • Inpatient sub-acute care in a hospital
SECTION II (INTRO), SECTION II. A, SECTION II. B
To Pre-certify inpatient and intermediate behavioral health treatment (mental health or alcohol/substance abuse treatment).
OVERVIEW AND SECTION II. E PROGRAM FOR BEHAVIORAL HEALTH: MENTAL HEALTH AND ALCOHOL/ SUBSTANCE ABUSE
Mental Behavioral Health Benefits Outpatient Care • Outpatient visits • Intensive Outpatient Programs Note: • Outpatient Physical/Occupational/Speech therapy for medical conditions associated with autism or developmental delay is also covered.
Inpatient Care • Medically Necessary Inpatient mental health admissions in a hospital • Partial Hospitalization Programs • Inpatient detoxification and rehabilitation
Intermediate Care • Intensive Outpatient Programs • Partial Hospitalization Programs
Note: All Inpatient and Intermediate Care must be pre-certified.
… PARTIAL HOSPITALIZATION PROGRAMS (PHP) FOR MENTAL HEALTH AND INTENSIVE OUTPATIENT PROGRAMS (IOP) FOR MENTAL HEALTH AND ALCOHOL/ SUBSTANCE ABUSE PHPs and IOPs provide intermediate levels of coordinated care and can help prevent hospitalizations and restore maximum function in a clinically appropriate setting. To Pre-certify these services, call the Fund at (646) 473-6868. Note: Custodial
care charges for intermediate care rendered at a facility are not covered by the Fund. If you receive behavioral health services at a residential treatment center, only services that qualify as the covered services listed above will be covered.
SECTION VII.D WHAT IS NOT COVERED
• Charges for services that are custodial in nature, including custodial care charges at Skilled Nursing and Residential Treatment Facilities.
SECTION IX Experimental or Unproven
Any investigational or unproven treatment, procedure, facility, equipment, drug, device or supply which does not meet any one or more of the following criteria…The improvement in net health outcomes must be attainable under the usual conditions of medical practice, and be significant compared to conventional treatment. _______________________________________________________________
This summary only highlights the key changes made to the 1199SEIU National Benefit Fund for Health and Human Service Employees. Summaries of material modifications together with the Summary Plan Description make up your official plan descriptions; please keep them together and refer to them as necessary. If you would like to review the Plan Document or have any questions, please contact the Fund’s Member Services Representatives at (646) 473-9200.
The National Benefit Fund for Health and Human Service Employees believes it is a “grandfathered health plan” under the Patient Protection and Affordable Care Act (the “Affordable Care Act”). A grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted in 2010. Being a grandfathered health plan means that this plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for an external review process for claims appeals. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits. The Wage Class III plan is not a grandfathered health plan. Questions regarding which protections apply and which protections do not apply to a grandfathered health plan can be directed to the Plan Administrator at (646) 473-9200. You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at (866) 444-3272 or www.dol.gov/ ebsa/healthreform. This website has a table summarizing which protections do and do not apply to grandfathered health plans.
The plan sponsor of the 1199SEIU National Benefit Fund for Health and Human Service Employees reserv
This Summary of Material Modifications describes changes that affect your welfare benefit plan and updates the Summary Plan Description (“SPD”) and Summary of Benefits and Coverage (“SBC”) that was previously distributed to you. You should keep this summary with your current SPD and SBC until the booklet is updated to reflect the changes discussed herein.
Effective on or about September 14, 2021, the 1199SEIU Greater New York Benefit Fund (the “Fund”) SPD and SBC shall be amended to provide that the Plan will cover Partial Hospitalization Programs (“PHP”) for substance abuse disorders, and to clarify its restrictions on custodial care charges. The following underlined and bold language shall be added to the SPD and the strikethrough language shall be omitted:
SECTION II.C
Benefit Brief • Benefits are not provided for care in a sub-acute nursing home or skilled nursing facility
WHAT IS NOT COVERED
... • Care or service in a nursing home, skilled nursing facility, rest home or convalescent home • Custodial care or sub-acute care in a hospital, residential facility, nursing home, or any other institution • Care in a skilled nursing facility other than hospice care as described
in this Section
SECTION II (INTRO)
To pre-certify inpatient and intermediate behavioral health treatment (mental health or alcohol/substance abuse).
SECTION II.B
• To pre-certify inpatient and intermediate mental health or alcohol/substance abuse treatment;
OVERVIEW and SECTION II. E PROGRAM FOR BEHAVIORAL HEALTH: MENTAL HEALTH AND ALCOHOL/ SUBSTANCE ABUSE
Mental Behavioral Health Benefits Outpatient Care • Outpatient visits – $5 co-payment • Intensive Outpatient Programs (IOP)
Note: Outpatient Physical/Occupational/Speech therapy for medical conditions associated with autism or developmental delay is also covered. See Section II.H.
Inpatient Care • Medically Necessary Inpatient mental health admissions in a hospital • Partial Hospitalization Programs (PHP) • Inpatient detoxification and rehabilitation
Intermediate Care • Intensive Outpatient Programs • Partial Hospitalization Programs Note: All Inpatient and Intermediate Care must be pre-certified.
ALCOHOL/SUBSTANCE ABUSE BENEFITS When Medically Necessary, you are covered for diagnosis and treatment of alcoholism and/or substance abuse. Outpatient Care • Outpatient visits– $5 co-payment • Intensive Outpatient Programs(IOP) Inpatient Care • Medically Necessary services for inpatient detoxification and rehabilitation …
PARTIAL HOSPITALIZATION PROGRAMS FOR MENTAL HEALTH AND INTENSIVE OUTPATIENT PROGRAMS FOR MENTAL HEALTH AND ALCOHOL/SUBSTANCE ABUSE Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP) provide intermediate levels of coordinated care and can prevent hospitalizations and help to restore maximum function in a clinically appropriate setting.
Note: Custodial care charges for intermediate care rendered at a facility are not covered by the Fund. If you receive behavioral health services at a residential treatment center, only services that qualify as the covered services listed above will be covered.
SECTION II.H
… • Physical/Occupational/Speech therapy: up to 25 visits per discipline per year. Prior approval is required for additional visits. Habilitation therapies are not covered to the extent there is other coverage available from either a government agency or program through a special organization.
SECTION II.I SERVICES REQUIRING PRIOR AUTHORIZATION
…
RE/HABILITATIVE THERAPIES Physical/Occupational/Speech therapies beyond 25 visits per discipline per year must be authorized in advance by the Plan Administrator.
SECTION VII.D WHAT IS NOT COVERED
• Charges for services that are custodial in nature or inpatient charges for
intermediate care.
This summary only highlights the key changes made to the 1199SEIU Greater New York Benefit Fund. Summaries of material modifications together with the Summary Plan Description make up your official plan descriptions; please keep them together and refer to them as necessary. If you would like to review the Plan Document or have any questions, please contact the Fund’s Member Services Representatives at (646) 473-9200.
The plan sponsor of the 1199SEIU Greater New York Benefit Fund reserves the right to amend or terminate the Fund, or any part of it, at any time.
1199SEIU Benefit and Pension Funds 498 Seventh Avenue New York, NY 10018-0009
www.1199SEIUBenefits.org
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Important Benefit Notices Inside this Issue
Avisos Importantes sobre Beneficios en este Numero
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