Welfare

Sheet Metal Workers' International Association Local Union No.73 Pension Welfare and Annuity Funds
	IMPORTANT CONTACT INFORMATION IMPORTANT BENEFIT INFORMATION SCHEDULE OF BENEFITS ELIGIBILITY FOR BENEFITS Your Initial Eligibility Your Dependents' Eligibility Qualified Medical Child Support Order (QMCSO) Continuation of Eligibility Termination of Your Eligibility Termination of Dependent Eligibility Reinstatement of Eligibility Enrollment Procedures Special Enrollment Certificate of Coverage LIFE EVENTS Getting Married Adding a Child Getting Divorced or Legally Separated Child Losing Eligibility Taking a Family and Medical Leave of Absence Taking a Military Leave In the Event of Death When You Stop Working or Retire CONTINUATION OF HEALTH BENEFITS Continuation of Coverage After You Die Continuation of Coverage During Family and Medical Leave Continuation of Coverage During Military Leave COBRA Continuation of Coverage COMPREHENSIVE MAJOR MEDICAL BENEFIT (EMPLOYEES AND DEPENDENTS) Preferred Provider Organization (PPO) Calendar Year Deductible Common Accident Coinsurance Out-of-Pocket Maximum Pre-Admission Authorization Covered Expenses Hospice Benefit Extension of Benefits WELLNESS EXPENSE BENEFIT (EMPLOYEE AND SPOUSE ONLY) SUBSTANCE ABUSE EMPLOYEE ASSISTANCE PROGRAM (EAP) (EMPLOYEE AND DEPENDENT) DENTAL BENEFITS (EMPLOYEES AND DEPENDENTS) Delta Preferred Option USA (Point-of-Service) Program Predetermination of Benefits Covered Dental Services Dental Service Limitations Services Not Paid by the Plan Dental Exclusions Extension of Dental Benefits OPTICAL BENEFITS (EMPLOYEES AND DEPENDENTS) HEARING AID BENEFIT (EMPLOYEES AND DEPENDENTS) PRESCRIPTION DRUG BENEFITS (EMPLOYEES AND DEPENDENTS) Retail Pharmacy Network Mail Order Prescription Drug Service Prescription Drug Exclusions and Limitations Prescription Drug Benefits Coordination with Medicare Part D DEATH BENEFIT (ACTIVE EMPLOYEES ONLY) ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS (ACTIVE EMPLOYEES ONLY) WEEKLY ACCIDENT AND SICKNESS DISABILITY BENEFIT (ACTIVE EMPLOYEES ONLY) Termination of Eligibility Reinstatement of Eligibility GENERAL EXCLUSIONS AND LIMITATIONS HOW TO FILE A CLAIM Filing Claims Other than Major Medical Claims Workers' Compensation Claims Procedures Claim Filing Period Assignment of Benefits Comprehensive Major Medical Benefit Claims Weekly Accident and Sickness Disability Benefit Claims If Your Claim is Denied Appealing the Denial of Your Claim Limitation on Legal Actions Payment of Benefits Misrepresentation or Falsification of Claim and Wrongfully Paid Benefits COORDINATION OF BENEFITS Determining Which Plan Pays First Information Required for Coordination of Benefits HOW MEDICARE AFFECTS MEDICAL BENEFITS UNDER THE PLAN About Medicare Coordination of Your Plan Benefits with Medicare REIMBURSEMENT POLICIES AND PROCEDURES Benefits to Which Reimbursement Applies Situations Where Reimbursement Provisions May Apply Reimbursement Procedures Refusal to Cooperate In Reimbursement Claims IMPORTANT INFORMATION ABOUT THE PLAN STATEMENT OF RIGHTS UNDER THE EMPLOYEE RETIREMENT INCOME SECURITY ACT (ERISA) YOUR PRIVACY RIGHTS UNDER THE PLAN DEFINITIONS APPENDIX A: DURABLE MEDICAL EQUIPMENT AND SUPPLIES