San Diego Roofers Health and Welfare Trust Fund [3h]

This Plan is considered a health and welfare plan which provides medical, dental and life insurance benefits. For more information, you can download a copy of the Summary Plan Description here.

>> Summary Plan Description

Coverage is provided by the following providers:

Kaiser Permanente HMO Medical Plan
800-464-4000
www.kp.org

Dental Plan
San Diego Roofers Health & Welfare Plan
3444 Camino del Rio North #101
San Diego, CA 92108
800-886-7559

Lincoln Financial
Life and AD&D Provider (Active participants only)


Eligibility

Only Coast Benefits, Inc. may confirm your eligibility status or accept appeals to the Board of Trustees concerning your eligibility for benefits or for self-funded medical or dental benefits. For appeals on issues with regard to an HMO (Kaiser Permanente) must be directed to that HMO. Appeals for dental benefits must be processed through Coast Benefits.

Your coverage becomes effective on the first day of the second month following any four consecutive months in which you have worked for covered employers for a minimum of 400 hours; example 400 hours combined during February, March, April, May gives eligibility July 1st. Coverage will continue if you work 100 hours per month for covered employers. Hours worked are reported by your employer in the following month and credited to your account the next following month. For example, covered hours worked in January would be credited to your account in February. Hours worked in excess of 100 per month are added to an hour bank for up to a maximum of 400 hours at any one time. When you are not credited with 100 hours in a given month, hours will be withdrawn from your hour bank to make up the required 100 hours for that month. For more information on your hour bank, please contact Coast Benefits, Inc.

To view a summary of the benefits available from these providers please choose a link:

>> Kaiser Permanente
>> Dental Benefits

The Trust Fund provides a self-funded dental plan.

If you or your dependents incur covered dental expenses in excess of the deductible, the Plan will pay a maximum of the amount shown in the Table of Allowance for Dental Procedures.

Deductible

The annual deductible is $50 per person. You must satisfy this amount of covered dental expense before benefits become payable under the Plan. The deductible is applied once in each calendar year for each covered person (up to a maximum deductible of $150 per family). The deductible does not apply to charges for the following preventative care services: exam, cleanings, fluoride treatment, x-rays, sealants for children to age 14.

COBRA Continuation Coverage

Every covered person who loses coverage due to a qualifying event may be eligible for COBRA Continuation Coverage. Qualifying events include the death of the participant, divorce or legal separation from the participant, ceasing to qualify as a dependent child, and loss of coverage due to termination of employment or reduced hours. Under certain circumstances, a dependent has a separate right to elect COBRA coverage. For more information on COBRA coverage, please contact Coast Benefits, Inc.

Health Reimbursement Arrangement

Effective with hours worked on/after February 1, 2019, $0.25 per hour of employer contributions will be designated towards a Health Reimbursement Account. The HRA Plan will be designed to supplement the hospital, medical, and dental benefits available to Participants plus provide reimbursement for eligible expenses not covered elsewhere. These amounts will be held in suspense until such time as the Trustees have finalized the HRA Plan. More information and details will be sent out at that time.






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