Retiree Health & Welfare
Health & Welfare Plan
Facts About Your Plan
SPD Navigation
Name and Type of Administration of the Plan
The Plan is known as the Operating Engineers Health and Welfare Fund. It is a collectively bargained, jointly-trusteed, labor-management trust.
Type of Plan
The Plan is an employee welfare benefit plan maintained for the purpose of providing health benefits for participants in the Plan.
Plan Identification Numbers
The Employer Identification Number (EIN) issued by the Internal Revenue Service is 95-6034886. The Plan Number is 003.
Agent for Service of Legal Process
The name and address of the agent designated for the service of legal process is:
Michael B. De Chellis
Operating Engineers Funds, Inc.
100 Corson Street, Suite 100
Pasadena, CA 91103 (626) 356-1000
Legal process may also be served on a Plan Trustee.
Plan Administrator
The Board of Trustees is the Plan Administrator. This means that the Board of Trustees is responsible for seeing that information regarding the Plan is reported to government agencies and disclosed to Plan participants and beneficiaries in accordance with ERISA.
The Board of Trustees has designated the following administrative organization to perform the routine administrative functions and day-to-day business of the Plan:
Operating Engineers Funds, Inc.
100 Corson Street, Suite 100
Pasadena, CA 91103
(626) 356-1000
Board of Trustees
The Board of Trustees consists of an equal number of employer and union representatives selected by the employers and union in accordance with the provisions of the Trust Agreement. If you wish to contact the Board of Trustees, you should use the following address and phone number:
Operating Engineers Health and Welfare Fund
100 Corson Street, Suite 100
Pasadena, CA 91103
(626) 356-1000
Names, Titles and Addresses of the Trustees
As of September 2022, the Trustees of the Fund are:
| Union Trustees | Employer Trustees |
|---|---|
| David K. Sikorski David Garbarino Ken Hunt Shawn Kinsey Perry Hawkins Robert Ninteman Joe Rangel, Jr. |
Jim Ryan Michael Crawford Stanley Howard Patrick Velasquez Jaimie Angus George Butorovich Dave Greco |
Collective Bargaining Agreements
The Plan was established, and is maintained, through collective bargaining agreements between the International Union of Operating Engineers, Local Union No 12, and participating employers. Contributions to this Plan are made on behalf of each Participant in accordance with these collective bargaining agreements.
The Fund Office will provide you, upon written request, a copy of any of the collective bargaining agreements. The collective bargaining agreements are also available for examination at the Fund Office.
Source of Contributions
The benefits described in this booklet are provided through employer contributions to this Plan. The amount of employer contributions is determined by the provisions of the collective bargaining agreements which require contributions to this Plan at a fixed rate per hour worked. The Fund Office will provide you, upon written request, information as to whether a particular employer is contributing to this Plan on behalf of participants working under the collective bargaining agreement.
Trust Fund
The assets and reserves of the Plan are held in trust by the Board of Trustees.
Plan Amendment and Termination
The benefits provided under the Plan are not permanent. The Board of Trustees reserves the right, in its sole discretion at any time and from time to time to:
- Terminate or amend the amount or condition of any benefits even though such termination or amendment affects claims which you may already have incurred.
- Change or postpone the method of payment of any benefit.
- Amend or cancel any other provision of the Plan.
The Trustees do not promise to continue the benefits and coverages in full or in part in the future, and rights to future benefits and coverages are not vested. This means they can be taken away. In particular, retirement or the completion of the requirements to receive a pension benefit under the Operating Engineers Pension Plan does not give any Participant or former Participant any vested right to continued benefits or coverages under the Operating Engineers Health and Welfare Fund.
The Board of Trustees is authorized and empowered to:
- Decide the meaning of any doubtful or ambiguous provision of the Rules and Regulations of the Plan.
- Decide on a Participant’s entitlement to or application for benefits under the Rules and Regulations of the Plan.
- Sign agreements, write and carry out reasonable Rules and Regulations, and do all things necessary in the establishment, maintenance and administration of the Plan.
If the Plan terminates, any and all money and assets remaining in the Fund, after payment of expenses, will be used to continue the benefits provided by the Plan, until such money and assets have been used up.
Funding
Benefits of the Plan are provided under service agreements or insurance contracts or directly from the Fund’s assets, which are accumulated under the provisions of the collective bargaining agreements and the trust agreement, and are held in trust for the purpose of providing benefits to covered Participants and defraying reasonable operating costs.
- PPO hospital, PPO medical, prescription drug, hearing aid, dental, vision, life and accidental death and dismemberment and weekly disability income benefits are paid directly from Fund assets.
- Prepaid medical and prescription drug benefits are provided through Kaiser, Anthem Blue Cross, Health Plan of Nevada and United HealthCare.
- Prepaid dental benefits are provided through United Concordia, Delta Dental, MetLife, and Western Dental (MIB).
Organizations Through Which Benefits Are Provided
The carriers listed below provide fully insured benefits under the Plan.
| Prepaid Dental Benefits | |||
|---|---|---|---|
| Delta Dental 12898 Towne Center Drive Cerritos, CA 90703 |
MetLife Dental 505 N. Euclid St., Suite 200 Anaheim, CA 92803 |
United Concordia Dental Plan of California PO Box 10194 Van Nuys, CA 91420 |
Western Dental (MIB) 530 S. Main St. Orange, CA 92868 |
| Prepaid Medical and Prescription Drug Benefits | |
|---|---|
| Anthem Blue Cross 21281 Burbank Blvd Woodland Hills, CA 91367 |
Health Plan of Nevada PO Box 15645 Las Vegas, NV 89114 |
| Kaiser Permanente 393 E. Walnut St. Pasadena, CA 91188 |
UnitedHealthcare 9900 Bren Road East Minnetonka, MN 55434 |
The Plan is fully self-insured for the benefits obtained through the companies listed below. These companies administer at least a portion of the benefits for the Plan, but do not insure or otherwise guarantee any of the benefits of the Plan.
| Company | Benefits |
|---|---|
| Anthem Blue Cross PO Box 60007 Los Angeles, CA 90060-0007 |
Provides access to its network of hospital and medical providers, performs healthcare management services, provider credentialing and claims screening. |
| OptumRx P. O. Box 29044 Hot Springs, AR 71903 |
Administers the prescription drug benefit. |
| Vision Service Plan of America 100 Howe Ave. Sacramento, CA 95825 |
Administers the vision benefit and provides access to its network of vision providers. |
| Carelon Behavioral Health 200 State Street Boston, MA 02109 |
Administers the Member Assistance Program, mental health and substance abuse benefits. |
Individual conversion policies are provided by Kaiser Permanente, Anthem Blue Cross and Health Plan of Nevada (hospital, medical and prescription drug coverage).
All benefit types provided by the Plan are set forth in this summary plan description. The complete terms of the Vision Care Benefits are set forth in the Agreements with Vision Service Plan. The complete terms of the prepaid benefits are set forth in the Kaiser Permanente Group Hospital and Medical Service Agreement, the Anthem Blue Cross Group Hospital and Professional Service Agreement, the Health Plan of Nevada Service Agreement, the Delta Dental Plans Service Agreement, the MetLife Dental Services Agreement, the United Concordia Service Agreement and the Western Dental-MIB Benefit Plans Service Agreement. The complete terms of the self-funded benefits are set forth in the Rules and Regulations which are available to any participant at any time.
Fiscal Plan Year
The fiscal records of the Plan are kept separately for each fiscal Plan Year. The fiscal Plan Year begins on July 1 and ends on June 30.
The Plan’s Requirements with Respect to Eligibility for Participation and Benefits
For Eligibility Requirements, refer to Eligibility.
Circumstances Resulting in Disqualification, Ineligibility or Denial or Loss of Benefits
Loss of eligibility is described throughout this booklet. For additional information please contact the Fund’s Member Services department at: (866) 400-5200.
Procedures to Follow for Filing a Claim
The procedure to be followed in filing a claim for benefits is outlined in Filing a Claim for Benefits.
Claims submitted must be accompanied by any information or proof requested and reasonably required to process such claims by the Fund Office or the Board of Trustees.
Review Procedure
If your claim is denied, in whole or in part, you will receive a written explanation giving detailed reasons for the denial, specific reference to the Plan provisions on which the denial is based, a description of any additional material or information necessary for you to perfect the claim and any explanation of why such information or material is necessary, as well as an explanation of the Plan’s claim Appeals Procedure.
Revised 07/2024