HEALTHCENTERBENEFITSBOOKLETJanuary 2019Benefits SummaryThe below chart is a summary of the major benefits and services enjoyed by Health Center members and their dependents. The benefits described here are subject to eligibility rules and exclusions that are explained in this booklet. Please review it carefully and contact the Health Center if you have any questions. MedicalOpticalPharmacyAll members/spouses• Annual physical exam• Biannual eye exam • Diagnostic physician visits and specialist consultations• Screening tests (e.g mammography, colonoscopy)• Outpatient laboratory testing and radiology testing (x-rays, other imaging)• Urgent care visits• Social service counseling• Adult Immunizations (e.g. influenza, shingles, pneumonia)• Free eyeglasses every 2 years (select models)• Designer frames and premium lenses at whole-sale cost• Routine adjustments• Zero co-pay for drugs costing less than $4• Generics: 30-day supply-$4• Generics: 31-to-90-day supply - $10• Preferred Brand Drugs - $10• Non-Preferred Brand Drugs- $20Retired members/spouses• All medical services above plus:• Office visits for management of diseases• Ongoing specialist physician care• Office procedures• Office delivered injections/infusions • Outpatient chemotherapy and radiation therapy• Podiatry services at SHHC• Outpatient physical, occupational and speech therapy• Dialysis servicesSee aboveSee aboveDepen-dent Children (<26 years old and covered by member’s primary insurance)NoneSee aboveSee aboveAssociate members/spouses (see Part III of this booklet)NoneDesigner frames and premium lenses at wholesale costPrescriptions at pharmacy costA summary of the eligibility requirements for retirees who turn 60 on or after January 1, 2019 is inside the back cover of this booklet.1January 2019750 East AvenueRochester, NY 146072Table of ContentsI. Introduction and History .......................................................................6 Sidney Hillman .......................................................................................6 History of the Health Center ..................................................................8 Your Current Health Center ..................................................................12 Important Features ..............................................................................12 Key insurance terms .............................................................................16 Premium ...............................................................................................16 Co-payment ..........................................................................................16 Co-insurance ........................................................................................16 Deductible ............................................................................................16 Out-of-pocket maximum ......................................................................16 Other Important Definitions ................................................................16 Covered Employment ...........................................................................16 One Year of Service ..............................................................................16 Break Year ............................................................................................16 Disability ...............................................................................................17 Retired ..................................................................................................17 Spouse ..................................................................................................17II. Benefits and Coverage .......................................................................18 Accessing Your Benefit .........................................................................18 Benefits and Covered Services .............................................................20 For All Members (including spouses) ...................................................20 Additional Benefits for Retired Members (including spouses) .............20 Benefits for Dependents ......................................................................21 Not Covered .........................................................................................21 Urgent Care Locations ..........................................................................22 Important Health Center Phone Numbers ...........................................23 Pharmacy Services ...............................................................................24 Optical Services ....................................................................................26 Podiatry Services ..................................................................................26 Social Service Counseling .....................................................................27 Insurance Navigation ............................................................................27 Scheduling ............................................................................................27 Additional Information .........................................................................283Table of ContentsIII. Eligibility ...........................................................................................30 Active Member Benefit Eligibility .........................................................30 Standard Active Member Benefit .........................................................30 Option for Members Over 50 ...............................................................31 Retiree Benefit Eligibility ......................................................................31 Grandfathering of Retiree Coverage for those who are 60 as of January 1, 2019 .....................................................31 Standard Retiree Eligibility ...................................................................32 Deferred Retiree Eligibility ...................................................................33 Special Situations .................................................................................34 Social Security Disability.......................................................................34 Active Duty in the U.S. Armed Forces ..................................................34 One-Year Extension for Layoff or Disability ..........................................35 Plant Closing Provisions .......................................................................35 Disabled Dependents Over Age 26.......................................................35 Associate Member Benefit Eligibility ...................................................36 Eligibility Rules .....................................................................................36 Termination of Eligibility ......................................................................36 Associate Member Benefits .................................................................37 Conditions of Associate Membership ..................................................37IV. Your Rights & Other Legal Information ..............................................40 Strictly Confidential ..............................................................................40 Benefits Limited to Fund Assets ...........................................................40 What to do if You are Denied a Benefit ................................................41 Extending Time Limits ..........................................................................43 Decision of the Executive Committee is Final ......................................43 Your Right to Sue ..................................................................................43 Your Rights Under ERISA ......................................................................44 Receive Information About Your Plan and Benefits .............................44 Continuation Coverage under COBRA ..................................................45 Prudent Actions by Health Center Fiduciaries......................................45 Non-Discrimination ..............................................................................46 Enforce Your Rights ..............................................................................46 Assistance with Your Questions ...........................................................474A Message from The Hillman President and Joint Board ManagerYour Sidney Hillman Health Center (SHHC) is one of the most unique benefits provided by an American Labor Union. The breadth and depth of benefits and services are unmatched. It was about seventy years ago when our Joint Board leader, Abe Chatman, realized that our union members were struggling to obtain decent, affordable health care for themselves and their families. That realization launched the beginning of the SHHC and even now, we work towards serving that need as the same struggle affects workers today.In an era when working Americans are paying increasing out-of-pocket cash for health care, SHHC remains a stead-fast benefit to union members. Some of these benefits include:• Deeply discounted prescription medications often priced at $0.00, $4.00, $10.00, and $20.00• Free annual physical exam• Free eye exam and eye-glasses every two years• More choices in the optical department including more designer frames• Full pharmacy and optical benefits for children under age 26 if they are covered under their parents’ health insurance• Expanded coverage of immunizations• Coverage of all lab and x-ray testing for active and retired workers• Free social work services• Expanded availability of after-hours and urgent care services• Coverage of high-cost services such as chemotherapy and dialysis5This hand-book provides a wealth of information regarding your health benefits. A copy of this book is posted on our website at: https://rrjb.org/shhc/ along with the latest SHHC information. I hope this information is helpful to you but if you have any questions, please call or visit the health center. Our staff can work with you to get the most out of your health insurance options and SHHC benefits.Sincerely,Gary Bonadonna, Jr.President, Sidney Hillman Health CenterManager, Rochester Regional Joint BoardInternational Vice President, Workers United6I. Introduction and HistorySidney HillmanThere have been many heroes in the long history of the labor movement, but few whose vision burned any brighter than Sidney Hillman, the man for whom your Health Center is named.Hillman was a remarkable man who played a central role in improving the lives of hundreds of thousands of American workers. He was born in 1887 in Zagare, Lithuania, received a rabbinical education, but then went to work in a chemical laboratory. Soon, the Czarist government threw him in prison for advocating labor reforms. After his release, Hillman eventually immigrated to the United States, and went to work in 1909 in a men’s clothing factory in Chicago. Within a year, he was leading a garment workers’ strike there.Sidney Hillman7Hillman subsequently moved to New York. In 1914, he was elected president of the Amalgamated Clothing Workers of America (ACWA), the forerunner of today’s Workers United organization. He served as ACWA president until his death in 1946. Hillman’s achievements at the helm of the union included:• Winning unemployment insurance long before it was legally required• Organizing two banks, which during the Great Depression preserved several garment businesses by loaning money or buying their stock• Playing a key role in securing the passage of the national Fair Labor Standards Act, establishing for the first time a nationwide minimum wage and legislation aimed at curbing sweatshops• Helping to found the Congress of Industrial Organizations (CIO)Hillman had a lifelong, passionate dedication to workers. In many ways, his entire philosophy was summed up in a newspaper interview shortly before his death. This excerpt shows why your Health Center is dedicated to his memory:“It is within the power of America to provide for our people conditions beyond the dreams of generations past… This Earth can be made a place where men and women can walk together in peace and friendship, and enjoy all that this work can provide. We want a better America, an America that will give its citizens, first of all, a higher and higher standard of living so that no child will cry for food in the midst of plenty.”- Sidney HillmanNext >

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