International Union of Operating Engineers Local 30 Benefits Trust Fund and Group Legal Services Trust Fund - Your Benefits and Group Legal Services Trust Funds at Work for You Summary Plan Description

Sep 17, 2026

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International Union of Operating Engineers Local 30 Benefits Trust Fund and Group Legal Services Trust Fund administer benefits through a joint Board of Trustees with equal voting power. The summary plan description explains trust-fund administration, eligibility and enrollment timing, life-event rules, COBRA continuation and conversion when employment ends, and guidance for retirement. It also details multiple medical plan options, prescription drug, dental, optical, short-term disability, life insurance, and AD&D benefits, along with group legal services and claim procedures including appeals, external review, and overpayment recovery.

LanguageEnglish

CategoryLetters

FormatPDF

Pages104

Reading Time36 min

AccessFree to download

INTRODUCTION

Benefits Trust Fund

Group Legal Services Trust Fund

ELIGIBILITY AND PARTICIPATION

Who’s Eligible

When Participation Begins

Enrolling for Coverage

When Coverage Ends

Reinstatement of Coverage

Keeping the Fund Informed

LIFE EVENTS AT-A-GLANCE

If You Get Married

If You Add a Child

If You Get Legally Separated or Divorced

If You Enter the Uniformed Services

If Your Child Loses Eligibility

In the Event of Your Death

If You Take a Family and Medical Leave

If Your Employment Ends: COBRA Continuation Coverage

If Your Employment Ends: Converting Your Coverage To Individual Coverage

WHEN YOU RETIRE

YOUR HEALTH BENEFITS

How the PPO Medical Plan Works

Empire BlueCross BlueShield Hospital Care

MAGNACARE PPO Medical Care

CIGNA Open Access Plus In-Network Copay Plan

YOUR PRESCRIPTION DRUG BENEFITS

YOUR DENTAL BENEFITS

How the Healthplex Dental PPO Plan Works

How the Aetna DMO Plan Works

How the DDS, Inc. Dental PPO Plan Works

YOUR OPTICAL BENEFITS

YOUR SHORT-TERM DISABILITY BENEFITS

YOUR LIFE INSURANCE BENEFITS

YOUR ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) INSURANCE BENEFITS

How AD&D Benefits Work

GROUP LEGAL SERVICES FUND

Eligibility

How the Plan Works

HOW TO CLAIM BENEFITS

How to File Claims

Claims Denial Notification

Appealing a Denied Claim (Non-Hospital Claims)

External Review for Claim Denied on Appeal

OTHER INFORMATION YOU SHOULD KNOW

Coordination of Benefits

Subrogation

Your Benefits and Group Legal Services Trust Funds at Work for You Summary Plan Description Main OFFice 115-10 Myrtle avenue Richmond Hill, nY 11418 Phone: (718) 847-8484 Fax: (718) 849-7546 INTERNATIONAL UNION OF OPERATING ENGINEERS LOCAL 30 BENEFITS TRUST FUND AND GROUP LEGAL SERVICES TRUST FUND The International Union of Operating Engineers Local 30 Benefits Trust Fund and Group Legal Services Trust Fund are administered by a joint Board of Trustees consisting of Union Trustees and Employer Trustees with equal voting power. | Union Trustees | Employer Trustees | | --- | --- | | William M. Lynn, Chairman | Frederick Ward | | Anthony Calandrino | John Culkin | | Brendan McPartland | Howard Fox | | Robert Moccio | Jack Larkin | | Kevin Cruse | Charles McGinley | | Fund Coordinator | Fund Auditor | | --- | --- | | Angelo DePietto | Novak Francella LLC | | Fund Counsel | Fund Consultant and Actuary | | --- | --- | | Barnes, Iaccarino & Shepherd LLP | The Segal Company | TABLE OF CONTENTS INTRODUCTION 1 Benefits Trust Fund 1 Group Legal Services Trust Fund 1 ELIGIBILITY AND PARTICIPATION 2 Who’s Eligible 2 When Participation Begins 2 Enrolling for Coverage 3 When Coverage Ends 3 Reinstatement of Coverage 4 Keeping the Fund Informed 4 LIFE EVENTS AT-A-GLANCE 5 If You Get Married 5 If You Add a Child 5 If You Get Legally Separated or Divorced 5 If You Enter the Uniformed Services 6 If Your Child Loses Eligibility 7 In the Event of Your Death 7 If You Take a Family and Medical Leave 7 If Your Employment Ends: COBRA Continuation Coverage 8 If Your Employment Ends: Converting Your Coverage To Individual Coverage 11 WHEN YOU RETIRE 12 YOUR HEALTH BENEFITS 13 HOW THE PPO MEDICAL PLAN WORKS 14 How Benefits Are Determined 14 EMPIRE BLUECROSS BLUESHIELD HOSPITAL CARE 15 When You Go In-Network 15 When You Go Out-Of-Network 15 Empire BlueCard® 15 Pre-certifying Care 16 Overview of Eligible Empire BlueCross BlueShield Expenses 17 Emergency Care 19 Inpatient Hospital Care 20 Ambulatory Services 20 Pregnancy and Maternity Care 21 Skilled Nursing Facilities 21 Hospice Care for the Terminally Ill 22 Home Health Care 22 Physical Therapy 22 Occupational, Speech or Vision Therapy 23 Organ and Tissue Transplants 23 MAGNACARE PPO MEDICAL CARE 24 When You Go In-Network 24 Selection of a Primary Care Provider 24 Direct Access to Obstetricians and Gynecologists 24 When You Go Out-Of-Network 25 Benefit Maximums 25 Overview of Eligible MagnaCare Expenses 26 General Medical Care 29 Preventive Care 30 Durable Medical Equipment and Supplies 31 What’s Not Covered by the PPO Medical Plan (BCBS Hospital and MagnaCare) 31 CIGNA OPEN ACCESS PLUS IN-NETWORK COPAY PLAN 34 When You Go In-Network 34 Prior Authorization 34 Summary of Benefits 34 Benefits 35 Exclusions 38 Additional Information 39 Exclusions 40 Selection of a Primary Care Provider 42 Direct Access to Obstetricians and Gynecologists 42 YOUR PRESCRIPTION DRUG BENEFITS 43 At the Pharmacy 43 Through Mail Order 43 Specialty Drug Management Program 44 If You Use an Out-of-Network Pharmacy 44 Annual Maximum Benefit 44 Eligible Drugs 44 Ineligible Drugs 45 YOUR DENTAL BENEFITS 46 TABLE OF CONTENTS continued HOW THE HEALTHPLEX DENTAL PPO PLAN WORKS 47 How Eligible Dental Expenses Are Defined 47 How to Use the Plan 47 Maximum Benefits 47 Pre-treatment Estimate 47 Schedule of In-Network (PPO) Copayments and Out-of-Network Dental Allowances 48 Benefits When Alternate Procedures Are Available 50 Determining When Treatment Begins 50 Benefits After Coverage Ends 50 What is Not Covered by the Healthplex Dental Plan 51 Coordination of Benefits (COB) 51 How to Claim Dental Benefits 51 HOW THE AETNA DMO PLAN WORKS 52 Your Primary Care Dentist 52 Overview of Eligible Aetna DMO Expenses 52 Benefits When Alternate Procedures Are

FAQs

How are the Benefits Trust Fund and Group Legal Services Trust Fund administered?

They are administered by a joint Board of Trustees consisting of Union Trustees and Employer Trustees with equal voting power.

When does coverage begin, end, and what happens after it ends?

Coverage begins based on eligibility and participation timing rules, ends according to coverage-ending conditions, and may be reinstated. When employment ends, COBRA continuation coverage or converting coverage to individual coverage may be available.

What medical plan options are described in the summary plan description?

The document explains how the PPO medical plan works and includes options such as Empire BlueCross BlueShield hospital care, MagnaCare PPO medical care, and the CIGNA Open Access Plus in-network copay plan with outlined in-network and out-of-network rules.

How do participants claim benefits and appeal a denied claim?

The document defines a claim, explains how to file claims, covers timing for filing, and describes making claim determinations and denial notifications. It also provides the appeal review process for denied claims and external review for certain claim denials.

Sep 17, 2026

Upload by Cipher