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FAQ

The answers to frequently asked questions below are general in nature and do not modify the terms of their respective Plans. You should refer to the related Summary Plan Description for more specific information regarding each Fund's Plan.

Top Frequently Asked Questions

What are some of the highlights of the C4 Plan?

  • C4 is an EPO, Exclusive Provider only Plan.
  • C4 is a high deductible plan with an annual deductible of $3,000 per individual and $7,500 per family.  Once the deductible has been met (the participant or another family member has paid the first $3,000 per person, or $7,500 for the family, of covered in-network services) then the Plan will pay 50% of covered expenses.  (Plan pays 50%, patient pays 50% for covered expenses up to the out of pocket maximum amount for that year).
  • Covered in-network benefits for hospital, medical (doctor visits, laboratory, and radiology), , surgery, etc. will be provided by Empire BlueCross BlueShield.  Prescription benefits will be provided by CVS/Caremark.  Certain services have a co-payment (a flat dollar payment that the patient pays to the provider at the time of the service) and are not subject to the co-insurance (50% cost sharing) such as emergency room visits.
  • Annually, the first three (3) primary care visits per covered family member are reimbursable at 100% for an in-network provider.  The deductible and co-insurance will apply at the fourth (4th) visit in that calendar year.
  • There is an overall out-of-pocket limit per person and that might change annual as directed by the Internal Revenue Service (IRS). Please check with the Fund Office or download Fund’s Summary of Benefits and Coverage document for the Plan(s) in question.  Once this limit has been reached the Plan will reimburse all covered in-network services for the balance of that calendar year at 100%.  This limit takes into account all monies paid by a participant or a family member out of his/her pocket for the following:                                                       
    • The annual deductible (for C4 it is $3,000 per individual/$7,500 per family – this is the amount that must be paid before the Plan makes any reimbursement).
    • All co-payments (the flat dollar amount paid at the time of a service; e.g. $250 for an emergency room visit under Plan C4).
    • All co-insurance payments – the 50% cost sharing for in-network services provided by physicians, laboratories, diagnostic tests, surgical services, prescription drugs, etc.  
  • Are there any items not subject to the out-of-pocket limit?
    • Yes, a participant or a covered family member will be wholly responsible for full payment of any out-of-network services or provider charges and for any item not covered under the Plan, and these payments will not count toward the out-of-pocket limit.  

Can I use my CAPP balance for a purpose other than paying the cost to enroll in one of the Plan C benefit options?

Yes, if, when you reach either the voluntary or automatic enrollment thresholds and you demonstrate to the Fund Office that you have other employer or union sponsored group health coverage that meets the minimum value standards of the Affordable Care Act (ACA) you can use your CAPP account for the Plan C medical reimbursement program. Please remember there is a quarterly $60 administrative fee and you must provide proof of qualifying other coverage EVERY year along with a signed certification of the ACA requirements by the open enrollment deadline which is typically December 15th to remain enrolled in this coverage option for the next calendar year.

When can I take a distribution from my individual account?

You (or your beneficiary, if applicable) may apply to receive the amount in your account when:

a. No employer contributions are made on your behalf to the Annuity Fund for 6 consecutive months because you are no longer working in covered employment if you are under age 55; or

b. No employer contributions are made on your behalf to the Annuity Fund for 2 consecutive months because you are no longer working in covered employment, and you have attained age 55; or

c. You die; or

d. You become totally and permanently disabled and are in receipt of a Social Security Disability Award; or

e. You retire at age 65, or if later, after you have been a Participant in the Plan for five years. 

What if I do not make a coverage co-payment timely?

Your coverage will be automatically downgraded to the next lower level of coverage if you do not make any applicable co-payment provided there is enough money in your account to do so. You may risk losing valuable family coverage if your account balance only supports single coverage. If there is not enough money in your account to be downgraded your coverage will lapse which means your coverage terminates. You will only be allowed to continue coverage through the COBRA self-payment provision of the Plan. In order to return to coverage you will need to first meet the $150 administrative fee and then your account balance must reach one month of the current cost C3 single Please see CAPP rates for the applicable amount as these rates may change from time to time.

Why is there an Out-of-Pocket Limit now on Plans A, C1, C2, C3, and C4?

The ACA places an annual limit on how much a person is required to pay out-of-pocket for covered services under a health plan.  Once a person has met that annual limit, the health plan must cover all covered services at 100% for the rest of the year. While Plans C2 and C3 already contained an out-of-pocket limit, Plans A and C1 did not.   And, the limits under Plans C2 and C3 did not include prescription drugs, which now count toward the annual limit starting January 1, 2015.  The annual limit includes amounts paid by a participant for all essential benefits: hospital, medical, diagnostic, laboratory, mental health services, covered therapies, prescriptions, etc.   (Services not covered by the Plan, such as out of network services under Plans C3 and C4, do not count toward the annual limit).  As briefly described above, deductibles, copayments, and co-insurance (percentage) payments are all added together as out-of-pocket monies a participant is spending/cost sharing with the Plan.  Once a participant’s spending reaches a certain dollar amount, then all further covered services in that same calendar year are paid at 100%.  This means that, after that point, no more out-of-pocket expenses have to be paid by the participant except for non-covered services and out-of-network provider charges that exceed the reasonable and customary dollar amount determined by BlueCross BlueShield (or all out-of-network provider charges if the participant is covered under an in-network-only option).

 The out-of-pocket limits under Plans A, C1, C2, and C3 are more generous than required by the ACA, that is, the Plans are reimbursing more than is required by law.

Are hardship withdrawals of my account balance permitted?

Yes. For contributions received on or after January 1, 2010. 

Plans C2 and C3 had Out-of-Pocket Limits before. Why have they increased?

The out-of-pocket limit that previously existed only took into account co-insurance percentages for hospital, medical, and surgical services.  Co-payments and deductibles for medical services and prescription drug co-payments and/or co-insurance percentage payments were not included in the limit.  Under the ACA, all essential benefits must be wrapped into an overall out-of-pocket limit (dental and vision benefits are not included as they are not essential benefits).   The existing limits were increased slightly to account for the added prescription utilization and the inclusion of co-payments and deductibles.  Once you have met the out-of-pocket limit, whether because you incurred expenses for different types of services, or just one (such as a hospitalization with or without surgical services or high prescription usage), the Plan will pay all remaining covered services at 100% for the remainder of the year in which you met the limit. 

Do I have to take a distribution of my account balance at a certain age?

No. You may continue to work as long as you like; retirement (a distribution) under the Annuity Fund is voluntary. However, if you are a 5% owner of the stock (or voting shares) of an Employer, your pension payments will automatically begin on the April 1st following the year in which you turn age 70 1/2, even if you are still working.  Minimum distributions will be made to you on the April 1st following attainment of age 70 ½ whether or not you are a 5% owner in accordance with applicable IRS regulations. 

Will the Plan’s Out of Pocket limits change for each Plan option in future years?

As limits increase under the ACA the Trustees will re-visit the Plans’ limits annually and decide if the limits need to be adjusted.

Are my Annuity benefits taxable?

Yes. Your benefits are normally taxable when you receive a distribution. Please contact your personal tax advisor for tax planning and advice.


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