SPD Active & Retiree Members Commercial Division

We are pleased to present you with this Summary Plan Description (“SPD”), which describes the benefits offered under the plan of benefits (the “Plan”) of the Health and Benefit Trust Fund of the International Union of Operating Engineers, Local 94-94A-94B, AFL-CIO (the “Fund”), that were in effect as of January 1, 2017 (unless specified otherwise herein). This SPD described more fully, the Plan that provides health benefits to eligible Members through agreements with Empire Blue Cross  Blue Shield (“Blue Cross”), CVS/Caremark and Sele-Dent Inc. (“Sele-Dent”), as the Fund’s other various vendors as well as from the general assets of the Fund. 

If you or your eligible dependents satisfy the eligibility requirements applicable to eligible members who are actively employed, PPO Retirees, or any individuals who have elected COBRA Continuation Coverage (as such requirements and term are defined in the Fund’s SPD) please refer to Empire Blue Cross Blue Shield’s Booklet (a copy of this booklet is attached as Appendix A to the Fund’s SPD) as well as to the Fund’s SPD for an overview of the medical, health care and hospitalization benefits offered under the Plan to eligible members who are actively employed, PPO Retirees, or any individuals who have elected COBRA Continuation Coverage as well as their eligible dependents.  

If you or your eligible dependents satisfy the eligibility requirements applicable to Retirees (as such requirements and term are defined in the Fund’s SPD) and are not eligible for Medicare and do not wish to purchase the PPO benefit, please refer to Empire Blue Cross Blue Shield’s Basic Retiree Booklet (a copy of this booklet is attached as Appendix B to the Fund’s SPD) as well as to the Fund’s SPD for an overview of the medical, health care and hospitalization benefits offered under the Plan.   

If you or your eligible dependents satisfy the eligibility requirements applicable to Retirees (as such requirements and term are defined in the Fund’s SPD) and are eligible for Medicare, please refer to Empire Blue Cross Blue Shield’s Medicare Retiree Booklet (a copy of this booklet is attached as Appendix C to the Fund’s SPD) as well as to the Fund’s SPD for an overview of the medical, health care and hospitalization benefits offered under the Plan. 

Appendix D is the Plan’s fee schedule for dental benefits. 

Appendix E is a partial list of Sele-Dents schedule of co-payments for dental benefits utilizing Sele-Dent’s PPO Network. 

Appendix F is the Health & Benefit Fund’s Notice of Privacy Practices.

To get more information on how the Health & Benefit Fund works for the Active and Retiree members in the Commercial Division you can download and read the SPD for the Active and Retiree Members in the Commercial Division and the Health and Benefit Fund Summary of Material Modifications (SMM) dated 2/10/20, 4/1/19, 12/26/18, 11/30/2018, 12/10/2017, 06/22/2020, 1/29/2021 and 5/25/2021