OPEIU Locals 30 & 537 Health & Welfare Fund Summary Plan Description - Revised Effective November 1, 2022

Sep 19, 2026

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Summary Plan Description revised effective November 1, 2022 for the O.P.E.I.U. Locals 30 & 537 Health & Welfare Fund. It explains eligibility rules, covered benefits, and how active members and their families can use benefits, including notes on limits and exceptions for Kaiser and United Concordia-related health and dental programs. It outlines claim procedures, plan governance and authority, required pre-certification and cost-containment rules, and provides contact information and notices for participants.

LanguageEnglish

CategoryGeneral

FormatPDF

Pages87

Reading Time30 min

AccessFree to download

Introduction

Fund establishment and contributions

Benefits overview and effective date

Foreign language notices

English notice

Spanish notice

Important notices

Updated materials and filing guidance

Trustees authority over plan administration

Eligibility, benefits, and claims

Eligibility determinations and benefit amounts

Pre-certification and cost-containment requirements

OFFICE & PROFESSIONAL EMPLOYEES INTERNATIONAL UNION LOCALS 30 & 537 HEALTH & WELFARE FUND SUMMARY PLAN DESCRIPTION REVISED EFFECTIVE NOVEMBER 1, 2022 To All Plan Participants: We are pleased to provide you with this new booklet which describes the Fund's eligibility rules and benefits for active members and their families. This booklet includes all changes made through November 1, 2022. Please review this booklet thoroughly to familiarize yourself with the latest changes. This booklet contains descriptions of all the benefits provided by the O. P. E. I. U. Locals 30 & 537 Health & Welfare Fund except for health benefits under the Kaiser Foundation Health Plan and dental benefits through United Concordia. Benefit programs under Kaiser and United Concordia are explained in separate booklets issued by these organizations. We hope that these benefits will protect you and your family members if any of you suffer illness or injury. We also hope that you will use your health benefits intelligently, taking advantage of the preferred provider discounts through AETNA and follow the rules requiring pre-certification of hospital stays and other cost containment features. By doing so, you will qualify for maximum benefits. At the same time, you will help the Fund operate in the most cost-effective way possible. In the pages that follow you will find a summary of benefits, the rules covering eligibility for those benefits, and the procedures that should be followed when making a claim. Contained in the back of the booklet is additional information about the O. P. E. I. U. Locals 30 & 537 Health & Welfare Fund as required by law. We also encourage you to visit [the Trust website at](the Trust website at www.opeiufunds.org)[ ](the Trust website at www.opeiufunds.org)[www.opeiufunds.org](the Trust website at www.opeiufunds.org). Only the Board of Trustees is authorized to interpret the rules and regulations described in this booklet. No individual Trustee, union representative, or employer representative is authorized to interpret the rules and regulations on behalf of the Board or to function as an agent of the Board. The Board of Trustees has authorized the Plan Administrator to respond in writing to written inquiries from Fund Participants. As a convenience to you, the Plan Administrator may provide oral answers regarding coverage on an informal basis. However, no such oral communication is binding on the Board of Trustees. Again, we strongly suggest that you read the entire contents of this booklet so that you will be familiar with the comprehensive protection the Fund provides you and your family. You may call the Plan Administrator at (562) 463-5065 or (800) 386-4350 should you have any questions. THE BENEFITS SUMMARIZED MAY OR MAY NOT WHOLLY APPLY TO YOU SINCE THE AGREEMENT BETWEEN YOUR EMPLOYER AND THE UNION MAY PROVIDE FOR ALL OR JUST SOME OF THE BENEFITS DESCRIBED. Sincerely, THE BOARD OF TRUSTEES INTRODUCTION This Fund was established as a result of collective bargaining between representatives of your Employer and Office and Professional Employees International Union Local 30 and Local 537. Contributions are paid by your Employer into a Trust Fund to provide Medical, Surgical, Hospital, Dental, Prescription Drug, Life and AD&D insurance and Vision Benefits for employees and their dependents. HOWEVER, THE AGREEMENT BETWEEN YOUR EMPLOYER AND THE UNION MAY PROVIDE FOR ALL OR JUST SOME OF THE BENEFITS LISTED HEREIN. The Board of Trustees determines policies and benefits in keeping with the assets and income of the Office and Professional Employees Locals 30 & 537 Health and Welfare Trust Fund. Benefits are subject to all the terms and conditions of the Trust Agreement as well as to any rules and regulations the Trustees may adopt from time to time. This booklet describes how you and your dependents may use these Benefits to the best advantage, when you are eligible. Please read it carefully and

FAQs

When does this Summary Plan Description take effect?

The effective date is November 1, 2022, and it replaces prior Summary Plan Descriptions and related benefit summaries issued before that date.

Which benefits are described, and which are explained in separate booklets?

The booklet summarizes benefits provided by the fund except health benefits under the Kaiser Foundation Health Plan and dental benefits through United Concordia, which are explained in separate booklets.

Who has authority to interpret the rules in the booklet?

Only the Board of Trustees is authorized to interpret the rules and regulations described. Other trustees, union representatives, or employer representatives are not authorized to do so on behalf of the Board.

Sep 19, 2026

Upload by Ben