Terms to Know

Beneficiary: a person designated by a participant or by the terms of the Health and Welfare Trust Fund to receive benefits.

Collective Bargaining Agreement: the labor agreement between the union and the employers and any amendments, or a labor agreement between the union and another employer.

Coinsurance: the participant’s share of the costs for health care services (usually calculated as a percentage) after the deductible is met.

Contributions: payments made by employers to the Trust Fund.

Copayment: a fixed amount participants pay for covered health care services.

Covered Person: any person covered under this Plan.

Deductible: a fixed dollar amount that participants must pay out-of-pocket each calendar year for covered medical services before the Plan begins to pay.

Dependent: your spouse and/or child eligible for coverage under this Plan.

Employee: anyone working for an employer on whose behalf the employer is required to make contributions under a written agreement with the Trust Fund. The word “employee” includes an individual working for the union on whose behalf the union is required to make contributions to this Trust Fund and an individual working for this Trust Fund on whose behalf the Trust Fund is required to make contributions to the Trust Fund.

Employer: includes any of the following:

• a party to the Trust Agreement with the union whose employees are represented by the union;
• one who is not presently a party to the Trust Agreement but whose employees are represented by the union and who satisfies the requirements for participation as established by the Trustees and agrees to be bound by the Trust Agreement;
• the union, but only for the limited purposes of making the required contributions into the Trust Fund on behalf of its employees at the rate fixed for contributions on behalf of other employees for the same Schedule of Benefits; and
• the Trust Fund, but only for the limited purposes of making the required contributions into the Trust Fund on behalf of its employees at the rate fixed for contributions on behalf of other employees for the same Schedule of Benefits.
• Fund, Welfare Fund, or Health and Welfare Fund refers to all property of whatever nature that is in the Milwaukee Drivers Health and Welfare Trust Fund as created by the Trust Agreement entered into on June 11, 1958, as amended.

In-Network Provider: a provider who has contracted with the Plan to provide services at a discounted amount for members of the Plan. Participants will pay less to see an in-network provider.

Qualifying Event: an event that provides the participant with the opportunity to elect COBRA Continuation Coverage within a certain timeframe.

Out-of-Network Provider: a provider who is not contracted with the Plan to provide services at a discounted amount for members of the Plan. If the Plan covers out-of-network services, you will pay more to receive those services from an out-of-network provider than from an in-network provider.

Out-of-Pocket Maximum: the most participants will pay out of pocket during a coverage period (usually one year) for their share of the cost of covered services under the Plan. Once this limit is met, the Plan will cover costs 100% for in-network services. This maximum does not include payments for out-of-network services.

Participant: any employee or former employee of an employer who is or may become eligible to receive a benefit of any type from the Trust Fund or whose beneficiary may be eligible to receive any such benefits.

Plan, Welfare Plan, or Health and Welfare Plan: the Milwaukee Drivers Health and Welfare Trust Fund Plan Document, program, rules, and procedures for the payment of benefits from the Trust Fund established by the Agreement and Declaration of Trust and amendments.

Precertification: an evaluation of the necessity, appropriateness, and efficiency of the use of medical services, procedures, and facilities. This includes reviews of necessary admissions, services ordered and provided, length of stay, and discharge practices.

Trust, Trust Agreement, or Agreement and Declaration of Trust: the documents, including all amendments and modifications, known as the Milwaukee Drivers Health and Welfare Trust Fund.

Trustees: the Trustees designated in the Agreement and Declaration of Trust, together with their successors designated and appointed in accordance with the terms of the Trust Agreement.

Union: Teamsters Local Union No. 344, Sales and Service Industry.