Health Provider and Coverage Information

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Benefits

The Wraparound Summary Plan Description (view here) provides a brief explanation of the Type 1 Benefits and an extensive explanation of the Type 2 Benefits offered by the Michiana Area Electrical Workers Health and Welfare Fund.

The following Type 1 Benefit Links supplement the Summary Plan Description by providing links to either a specific Type 1 Benefit program document or a more extensive explanation of the specific Type 1 Benefit program.

     1.    Medical And Prescription Drugs

Information about Type 2 Benefit programs can be found in the Wraparound Summary Plan Description.

Qualified Medical Child Support Orders Procedures

The Omnibus Budget Reconciliation Act of 1993 requires that group health plans recognize and comply with "Qualified Medical Child Support Orders." The Fund's procedure for processing medical child support orders that are claimed to be Qualified Medical Child Support Orders is as follows:

a.Receipt of Order

The Fund Office shall promptly notify the Participant and each alternate recipient (i.e., a person to receive benefits according to the Order) of the Order's receipt and the Fund's procedures for determining whether a medical child support order is a Qualified Medical Child Support Order. The Fund Office shall forward a copy of the Order to Fund Counsel.

b.Determination of Qualification

Within a reasonable period after receipt of such Order, the Plan Administrator, with the assistance of the Fund Counsel, shall determine whether such order is a qualified medical child support order and notify the Participant and each alternate recipient of such determination.

The procedures to determine whether medical child support orders are qualified medical child support orders shall follow the criteria established by Section 609 of ERISA, and any applicable regulation and administration actions by agencies charged to enforce Section 609. Those criteria include:

1.Inclusion of the order in a judgment order or decree made pursuant to state domestic relations law or made pursuant to state domestic relations law or made pursuant to a law relating to medical child support described in 42 U.S.C. § 1396g issued by a court of competent jurisdiction or administrative process that has the force or effect of law in the state issuing the order.

2.Creation, assignment or recognition of the right of an alternate recipient to receive Fund benefits to which a Participant or a beneficiary is entitled.

3.Whether the alternate recipient is a child of the Participant or a child adopted by or placed for adoption with a Participant.

4.Inclusion of the name and last known mailing address of the affected Participant and the name and last known mailing address of the alternate recipient.

5.Inclusion of a description of the type of coverage to be provided by the Fund or the manner in which such coverage is to be determined.

6.Identification of the period for which the order applies.

7.Identification of the Fund as the plan to which the order supplies.

8.Verification that the order does not require the Fund to provide benefits or a form of benefits other than one provided by the Fund, provided that the Fund shall satisfy requirements of applicable laws relating to medical child support described in 42 U.S.C. § 1908.

c.Effect of National Medical Support Notices

The Fund shall recognize as Qualified Medical Child Support Orders "National Medical Support Notices" that comply with the provisions of applicable final regulations under ERISA Section 609.

d.Status of Alternate Recipients

Alternate recipients shall be deemed Fund Participants for purposes of applicable reporting and disclosure requirements and shall be treated as Fund beneficiaries for all other purposes.

e.Direct Payments

Payments for benefits or claims for reimbursements made by alternate recipients under Qualified Domestic Child Support Orders shall be made to the alternate recipients or their legal guardians as applicable.

f.Direct Payments

The Fund Office shall notify an alternate recipient or the alternate recipient's legal guardian of its determination concerning a medical child support order which is claimed to be a Qualified Medical Child Support Order within a reasonable time after receipt. Alternate recipients shall be entitled to designate a representative for the receipt of copies of notices that are sent to the alternate recipient with respect to a medical child support order. The custodial parents or guardians of minor alternate recipients shall be considered their designated representatives absent an express written request of other representatives.

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