Welfare Fund

Retiree Basic 65 Plan

The Retiree Basic 65 Plan is a special benefit program for qualifying retirees who are age 65 or over. This Plan pays scheduled basic benefits for hospitalization and surgery only. The normal rules governing medical/dental/vision benefits, utilization review, use of PPO providers, the Prescription Drug Program, and COBRA coverage, do not apply to the Basic 65 Plan.

ELIGIBILITY FOR BASIC 65 PLAN

If you retire and meet the eligibility requirements described below, and do not (or did not) elect to make self-payments for the Retiree Comprehensive Plan, you and your spouse will be eligible for coverage under the Retiree Benefit Plan when you reach age 65.

In order to receive Basic 65 Plan benefits at no cost to you:

1. You must have been approved for a "30 and out" pension from the Local 734 Pension Fund; and
2. You must have at least 30 years of service in the Local 734 jurisdiction immediately prior to your retirement.

If you qualify for a disability pension from the Local 734 Pension Fund, you can also receive the Basic 65 Plan at no cost to you. The 30-and-out and 30-service-year requirements do not apply to disability pensioners.

You can make self-payments for the Basic 65 Plan if you qualify for a pension from the Local 734 jurisdiction immediately prior to your retirement:

1. If you retire between the ages of 60 and 64 with 15 years of service; or
2. If you retire at age 65 or older with five years of service.

SURVIVOR BENEFITS - If you die while covered under the Basic 65 Plan, your surviving spouse will continue to be covered under the Basic 65 Plan until she remarries.

BASIC 65 BENEFITS

Death Benefit

If you (the retiree) die due to any cause, a $1,000 Death Benefit will be paid to your beneficiary.

The proof of death and beneficiary designation rules for this benefit are the same as for retirees covered under the Retiree Comprehensive Plan.

Basic 65 Medical Benefits

When you reach age 65, the Plan will pay the amounts described below whenever you or your spouse incur covered hospital or surgical expenses.

Only services that are medically necessary and required in connection with the treatment of a person's injury or sickness are acceptable to be considered for payment.

No hospital or surgery benefits are payable for pregnancy-related expenses.

Basic 65 benefits are not payable for a person who has not reached their 65th birthday.

HOSPITAL BENEFITS - If a covered retiree or spouse is confined as a hospital inpatient, the Plan will pay up to $14 per day for a period of up to 31 days per period of confinement. The Plan will also pay up to a maximum of $140 per period of confinement for ancillary inpatient hospital services.

Successive periods of hospital confinement will be considered as one confinement unless the second confinement (or outpatient surgical procedure, if applicable) is due to a cause or causes unrelated to the prior confinement (or outpatient surgical procedure), or unless three months separate the confinements (or outpatient surgical procedures).

SURGERY BENEFITS - The Basic 65 Plan pays a schedule amount toward the surgeon's fee up to the maximum of $250 per procedure. If multiple surgical procedures are performed at the same time for related causes, only the greatest scheduled benefit will be paid.

If more than one surgical procedure is performed at the same time for unrelated causes, payment will be made for each procedure, but the total payment for all such procedures combined will not exceed the $250 maximum surgical benefit payable per period of disability.

In no event will the combined benefits payable for multiple procedures performed during one period of disability—whether the procedures are for related or unrelated causes—exceed the $250 per-disability maximum surgical benefit.

Successive surgical procedures will be considered to have been performed during one period of disability unless the later procedure is due to causes unrelated to the prior procedure or unless a period of at least three months separates the two procedures.

No payment will be made for surgery on the teeth or their surrounding structures unless the surgery is necessitated by an accidental injury.

Schedule of Surgery Benefits (Basic 65 Plan)

If the operation performed is not shown in the Schedule of Surgery Benefits above and is not expressly excluded by any of the terms of this Plan, the Fund Administrator shall determine the benefit payable for such operation. An operation of equivalent gravity and severity will be used as a basis for the Fund Administrator's determination.