OPERATING ENGINEERS PUBLIC AND MISCELLANEOUS EMPLOYEES HEALTH AND WELFARE TRUST FUND

EMPLOYER RESOURCE MANUAL – 2015 EDITION BOARD OF TRUSTEES Your Organization and the Operating Engineers Local 3 have come to a Memorandum of Understanding and therefore are able to provide you with the benefits available to Participants in the Operating Engineers Local 3 Public and Miscellaneous Employees Health and Welfare Trust Fund. The purpose of this Manual is to outline the relationship between the Board of Trustees, The Union, and the Employers that participate in the Plan.

The Operating Engineers Local 3 Public and Miscellaneous Employees Health and Welfare Trust Fund is jointly managed by a Board of Trustees. The Joint Board is comprised of Labor/Union Trustees and Management/Employer Trustees who establish policy for the Fund. The Trustees also select and hire Professionals including an Administrative Fund Manager. In this case, Associated Third Party Administrators (ATPA) is responsible for the daily operations. Union Management Russell E. Burns (Co-Chairman) Austris Rungis (Co-Chairman) Rick Davis (Director) John Gouveia Steve Ingersoll

OPERATING ENGINEERS PUBLIC AND MISCELLANEOUS EMPLOYEES HEALTH AND WELFARE TRUST FUND

EMPLOYER RESOURCE MANUAL – 2015 EDITION TABLE OF CONTENTS

1. Contact Information – Trust Fund Office 2. Contact Information - Providers 3. Fund Workflow 4. Role of the Trust Fund Office 5. Role of the Board of Trustees 6. Role of the Union 7. Employer Contribution Reporting Procedures 8. Sample Employer Bill 9. Enrollment Procedures 10. Sample Enrollment Form 11. Web ERF Information

OPERATING ENGINEERS PUBLIC AND MISCELLANEOUS EMPLOYEES HEALTH AND WELFARE TRUST FUND

EMPLOYER RESOURCE MANUAL – 2015 EDITION TRUST FUND OFFICE – CONTACT INFORMATION

Account Manager *Main Point of Contact*

Bill Boyle 1640 South Loop Road Alameda, CA 94502 (510) 337-3367 Cell: (510) 918-2144 bboyle@atpa.com

Senior Account Manager Greg Trento 1640 South Loop Road Alameda, CA 94502 (510) 337-3310 Cell: (925) 699-9175 gtrento@atpa.com

Billing & Eligibility Manager Daniel Jackson 1640 South Loop Road Alameda, CA 94502 (510) 337-3381 djackson@atpa.com

Service Center Manager Arron Robles 2151 Salvio Street, Suite 201 Concord, CA 94520 (925) 288-4014 Cell: (925) 381-0337 arobles@atpa.com

Billing & Eligibility Staff Pritilata Merchant, extension 3163

Kim Johnson, extension 3128 (800) 251-5014

OPERATING ENGINEERS PUBLIC AND MISCELLANEOUS EMPLOYEES HEALTH AND WELFARE TRUST FUND

EMPLOYER RESOURCE MANUAL – 2015 EDITION PROVIDER CONTACT INFORMATION

Health & Welfare – Trust Fund Office

800-251-5014

Medical Claims and Benefits Info

800-251-5013

Blue Cross

800-274-7767

Delta Dental

800-765-6003

Optum Rx

(866) 218-5445

Chemical Dependency – ARP

800-562-3277

Vision Service Plan

800-877-7195

Hearing Care Plan

800-322-4327

OPERATING ENGINEERS PUBLIC AND MISCELLANEOUS EMPLOYEES HEALTH AND WELFARE TRUST FUND

EMPLOYER RESOURCE MANUAL – 2015 EDITION FUND WORKFLOW

Trust Fund Office

Negotiates With Employer OE Public Employees

Union

New Enrollment Forms

Order to Bill

Union sends Order to Bill to Trust Fund Office

Memorandum Of

Understanding

Employer Contacts Trust Fund Office

with Any Questions

Answers participants’ questions regarding

eligibility

Trust Fund Office enters all participants’ basic data into

the system. Also enrolls participant and dependants into carrier and manually

updates carrier if eligibility is retroactive

Processes Order to Bill and updates rates on employer bill and/or sets up new employer

Bills Employer

Sends confirmation letter to participant

Enters & Processes all employer contributions and

reports monthly

OE Public Employees Union

Employer

Trust Fund Office

Order to Bill

New Enrollment Forms

Bills Employer

Trust Fund Office enters all participants’ basic data into

the system. Also enrolls participant and dependants into carrier and manually

updates carrier if eligibility is retroactive

Answers participants’ questions regarding

eligibility

Enters & Processes all employer contributions and

reports monthly

OPERATING ENGINEERS PUBLIC AND MISCELLANEOUS EMPLOYEES HEALTH AND WELFARE TRUST FUND

EMPLOYER RESOURCE MANUAL – 2015 EDITION THE ROLE OF TRUST FUND OFFICE

• Bills employers according to the Order to Bill provided by the Operating Engineers

Local 3 Union.

• Processes employer contributions and employer contribution report forms on a monthly basis.

• Processes and updates eligibility each month with the various carriers.

• Enrolls new participants with the selected carriers.

• Processes changes in carriers for all participants.

• Update Health & Welfare, Dental and Vision rates per the Board of Trustees directive.

• Mails out notices to participants and employers regarding plan changes, rate changed, federal mandates and other mailings pertaining to the Operating Engineers Public Health & Welfare Fund.

• Orders Medical and Prescription Drug cards for participants upon initial enrollment as well as by request.

• Corrects/updates participant’s data upon request.

• Participants can call the service center (800-251-5014) from 7 A.M. – 7 P.M. for questions. If the service center is unable to help the issues is escalated to a Billing & Eligibility Specialist.

• Manually update all participants on late employer contributions and new participants that missed the enrollment deadline.

Items Handled by the Employer, Union of Board of Trustees • The Trust Fund Office is not responsible for deducting money from a

participant/employee’s paycheck for health and welfare contributions.

• The Trust Fund Office does not negotiate contracts with the Union or employers.

• The Trust Fund Office does not negotiate or make decisions regarding the changes in Health & Welfare contribution rate amounts or Plan Changes.

OPERATING ENGINEERS PUBLIC AND MISCELLANEOUS EMPLOYEES HEALTH AND WELFARE TRUST FUND

EMPLOYER RESOURCE MANUAL – 2015 EDITION THE ROLE OF THE BOARD OF TRUSTEES

• Votes and makes Health & Welfare Plan changes.

Makes decision on Health & Welfare, Dental and Vision contribution rate amounts.

• Configures and decides the benefit structure of the Plan as well as selects the carriers and providers used.

• Creates and approves eligibility rules and/or amendments.

• Approves and/or denies appeals from employers and participants.

OPERATING ENGINEERS PUBLIC AND MISCELLANEOUS EMPLOYEES HEALTH AND WELFARE TRUST FUND

EMPLOYER RESOURCE MANUAL – 2015 EDITION THE ROLE OF THE UNION

• Service to the Members

• Negotiates contracts with individual employers.

• Sends the Order to Bill to the Trust Fund Office to commence billing and/or make any billing changes.

OPERATING ENGINEERS PUBLIC AND MISCELLANEOUS EMPLOYEES HEALTH AND WELFARE TRUST FUND

EMPLOYER RESOURCE MANUAL – 2015 EDITION EMPLOYER CONTRIBUTION REPORTING PROCEDURES

• Employers receive the contribution report from the Trust Fund Office on or before

the 5th of the month.

• Employer is to remove any terminated participants from the bill by lining through the participant’s name and indicating a termination date as well as the eligibility termination date next to the name.

• If the employer has any new employees/participants, their name, Social Security number and hire date should be written on the bill under the existing participants, along with the corresponding contribution rate and the effective date of eligibility.

• Once all terminated participants are removed and new participants are added the employer is to total up the amount of all Health and Welfare contribution rates and write the total at the bottom of the bill where indicated.

• The employer should remit payment in this amount along with the administrators copy of the contribution report to the bank lockbox at the following address:

OE Public and Miscellaneous Employees

PO Box 3157 Hayward, CA 94540-3157

(800) 251-5014

• All employer bills are due to the Trust Fund Office by the 25th of the month.

OPERATING ENGINEERS PUBLIC AND MISCELLANEOUS EMPLOYEES HEALTH AND WELFARE TRUST FUND

EMPLOYER RESOURCE MANUAL – 2015 EDITION SAMPLE EMPLOYER BILL

OPERATING ENGINEERS PUBLIC AND MISCELLANEOUS EMPLOYEES HEALTH AND WELFARE TRUST FUND

EMPLOYER RESOURCE MANUAL – 2015 EDITION ENROLLMENT PROCEDURES

• If an employer has a new participant, usually due to open enrollment, the

completed enrollment forms can be sent directly to the Trust Fund Office at the following address:

OE Public and Miscellaneous Employees

1640 South Loop Road Alameda, CA 945020

(800) 251-5014

• The eligibility effective date must be noted either on a cover sheet or on the top of the enrollment form. The enrollment form cannot be fully processed until this information is confirmed.

• Proper documentation including birth certificates for dependent children and marriage certificates for spouses are required for all new participants and for participants who are adding/dropping dependants.

• In addition to sending in the enrollment form with the eligibility effective date, the employer must add the participant to the employer contribution form and remit the appropriate payment that corresponds with the participant eligibility effective date.

• Please allow 48 – 72 hours for enrollment forms to be processed.

• If the employer is having an open enrollment and expects to send in a large number of enrollment forms, please notify the Trust Fund Office in advance if possible.

• Employers should allow up to one week to process the large number of enrollment forms from open enrollment periods, so please plan accordingly.

10

OPERATING ENGINEERS PUBLIC AND MISCELLANEOUS EMPLOYEES HEALTH AND WELFARE TRUST FUND

ACTIVE ENROLLMENT FORM P.O. Box 23190 Oakland, CA 94623-0190

1-800-251-5014 FAX 510-337-3080

PLEASE CHECK NEW PARTICIPANT CHANGE OF: NAME ADDRESS ALL THAT APPLY: PLAN MARITAL STATUS DEPENDENTS PARTICIPANT DATA - EMPLOYEE INFORMATION COMPLETE ALL INFORMATION – PLEASE PRINT IN INK LAST NAME

FIRST NAME INIT. SOCIAL SECURITY NUMBER

DATE OF BIRTH MAILING ADDRESS (STREET OR P.O. BOX)

GENDER (M/F)

CITY

STATE ZIP TELEPHONE NUMBER ( )

DATE OF MARRIAGE/DIVORCE

DATE OF HIRE MARITAL STATUS SINGLE MARRIED DIVORCED

EMPLOYER

CHOICE OF PLANS MEDICAL SELECTION – CHOOSE ONE:

COMPREHENSIVE

KAISER PERMANENTE HMO PLAN GRP #926

IF APPLICABLE, REGARDLESS OF CHOICE OF MEDICAL PLAN, ALL ELIGIBLE PARTICIPANTS AND THEIR ELIGIBLE DEPENDENTS HAVE: • DENTAL COVERAGE THROUGH

DELTA DENTAL (800-765-6003) • VISION COVERAGE THROUGH VSP

(800-877-7195)

COMPREHENSIVE PLAN PARTICIPANTS

PRESCRIPTION COVERAGE THROUGH CAREMARK (888-790-4258) KAISER PERMANENTE PLAN PARTICIPANTS PRESCRIPTION COVERAGE FOR KAISER PERMANENTE PARTICIPANTS MUST USE A KAISER PERMANENTE PHARMACY

Personal & Dependent Data Relation*

Last Name First Name Sex Date of Birth Social Security Number Receiving Medicare Part A or B

Kidney Transplant or Dialysis

Self

Yes □ No □

Yes □ No □

□ Spouse □ Domestic Partner**

Yes □ No □

Yes □ No □

Dep*

Yes □ No □

Yes □ No □

Dep*

Yes □ No □

Yes □ No □

Dep*

Yes □ No □

Yes □ No □

Dep*

Yes □ No □

Yes □ No □

* Relation –Son, Daughter, Stepson, Stepdaughter, Etc. Please see back for definition of “ELIGIBLE DEPENDENTS” ** Domestic Partner – the participant must apply and qualify separately for Domestic Partner eligibility through the Trust Fund Office.

Complete the section below and enclose a copy of the Medicare card if you or a dependent are enrolled in Medicare Please list the individual enrolled in Medicare Name:_________________________

Enrolled in Part A? Yes □ No □ Enrolled in Part B? Yes □ No □

Effective Date A: _____/_____/_____ Effective Date B: _____/_____/_____

Please list the individual enrolled in Medicare Name:_________________________

Enrolled in Part A? Yes □ No □ Enrolled in Part B? Yes □ No □

Effective Date A: _____/_____/_____ Effective Date B: _____/_____/_____

You must complete if you checked yes to kidney transplant or receiving kidney dialysis Please list the individual receiving Dialysis or Transplant Name:_________________________

Received Kidney Transplant Yes □ No □ Receiving Dialysis Yes □ No □

Date of Transplant:: _____/_____/____ Date of first treatment: _____/_____/____

OPERATING ENGINEERS PUBLIC AND MISCELLANEOUS EMPLOYEES HEALTH AND WELFARE TRUST FUND

EMPLOYER RESOURCE MANUAL – 2015 EDITION WEB ERF