Western Teamsters Welfare Trust

Name of Plan
This Plan is known as the Western Teamsters Welfare Trust Health and Welfare Plan for Retirees.

Name, Address and Telephone Number or Plan Sponsor and Administrator
This Active Regular Employees Plan is sponsored and administered by a joint labor-management Board of Trustees pursuant to an Agreement and Declaration of Trust. The name, address and telephone number of the Board of Trustees is:

Board of Trustees
Western Teamsters Welfare Trust
2323 Eastlake Avenue East
Seattle, Washington 98102
(206) 329-4900

Identification Numbers
The taxpayer identification number assigned to the Board of Trustees by the Internal Revenue Service is EIN 91-6033601. The Plan Number assigned to the Plan by the Board of Trustees is 501.

Type of Plan
This Plan is a Health and Welfare Plan providing medical, prescription drug, mental health and chemical depen-dency, dental, vision, weekly time loss, life, and accidental death and dismemberment benefits.

Type of Administration
This Plan is administered by the Board of Trustees with the assistance of contract administrative organizations which provide a Principal Trust Office and Area Administrative Offices, and other providers of services. For general information about the Plan, contact the Administrative Office in your area.

Name and Address of Agent for Service of Legal Process
The person designated as the Planís agent for service of legal process is:

Western Teamsters Welfare Trust
Administrative Manager
Principal Trust Office - Northwest Administrators
2323 Eastlake Avenue East
Seattle, Washington 98102

In addition, service of legal process on the Plan may be affected by service of process on the Board of Trustees at the Principal Trust Office or on any Trustee at their address.

Source of Contributions - Collective Bargaining Agreements
This Plan is maintained by local unions affiliated with the Teamsters Union and employers who are parties to collective bargaining agreements requiring contributions to the Western Teamsters Welfare Trust. These agreements generally provide that the employers who are parties thereto will make monthly contributions to the Western Teamsters Welfare Trust for the purpose of enabling eligible employees working under such agreements to participate in the Western Teamsters Welfare Trust. The contribution rates and the job classifications covered are specified in such agreements. The Plan is funded by these employer contributions (certain employees whose coverage would otherwise terminate may continue coverage for a limited period of time by making the required self-payments).

A copy of each of the applicable collective bargaining agreements is available for examination, without charge, by participants and beneficiaries, at the Trustís Area Administrative Offices. A copy of any of these documents may be obtained by participants and beneficiaries upon written request addressed to the Board of Trustees of the Western Teamsters Welfare Trust at the Principal Trust Office, 2323 Eastlake Avenue East, Seattle, Washington 98102. The Trustees will make a reasonable charge for providing copies of any documents requested.

Information on whether a particular employer or union is making contributions, and if so, the address of the employer or union, may be obtained by participants and beneficiaries without charge upon written request addressed to the Board of Trustees at the Principal Trust Office.

Funding Mechanism
The Retiree Plan is funded through negotiated employer contributions and retiree and spouse self-payments. Contributions and self-payments are paid into the Trust Fund and, as authorized by the Board of Trustees, are then allocated to: (a) the payment of premiums or fees to the insurance companies and health care providers who underwrite the benefit coverages and also, for the direct payment of self funded benefits; (b) the payment of administrative expenses; and (c) the maintenance of certain reserves.

The Trustees provide benefits to the extent monies are currently available to pay the costs of such benefits. Benefits are available on a month-to-month basis and are not guaranteed to continue indefinitely. The Board of Trustees reserves the discretion to modify the retiree plan or terminate completely as the circumstances may require.


Type Of Benefit Type Of Funding

Medical The Indemnity Medical Benefits are self-funded.

Monthly premiums are paid to the Health Maintenance Organizations (HMOs) listed below, to provide medical benefits to participants that elect to participate in these plans:

PacifiCare of Arizona
Kaiser Foundation Health Plan, Inc. Southern California
Kaiser Foundation Health Plan, Inc. Northern California
Kaiser Foundation Health Plan of Colorado
Kaiser Foundation Health Plan of Oregon
Group Health Cooperative of Puget Sound
Group Health Northwest
Cimarron Health Plan

Prescription Drugs The Indemnity Prescription Drug Benefits are administered by NBN/Rx and Merck-Medco Rx Services and are self-funded.

Managed Mental Health and Chemical Dependency Services Premiums are paid to Health Management Center, Inc. to provide benefits for mental health and chemical dependency services

Eligibility for Benefits

Circumstances Which May Result in Ineligibility or Denial of Benefits
The Board of Trustees has the authority to modify or terminate the benefits, in whole or in part, should financial circumstances so require.

Claims Appeal Procedures

Plan Year
The Plan year for this Plan is a twelve month period beginning September 1 and ending the following August 31, and is the fiscal year of the Plan for the purpose of accounting and reporting to the U.S. Department of Labor and other regulatory bodies.

Future of the Plan and Trust Fund
This Western Teamsters Welfare Trust shall remain in full force and effect until terminated by the action of the Trustees. The Trust Fund will also terminate upon the expiration of all collective bargaining agreements and special agreements requiring the payment of contributions to the Trust Fund. In the event of termination the Trustees shall:

  • Make provision out of the Trust Fund for the payment of expenses incurred up to the date of termination of the Trust and expenses incident to such termination.
  • Distribute the balance, if any, of the assets of the Trust Fund remaining in the hands of the Trustees in such manner as they determine will carry out the purpose of the Trust, including, but not limited to, the providing of existing insurance benefits on a pro-rata basis or the transfer of such funds to a successor trust having the same or similar purposes for the benefit of employees.
  • Arrange for a final audit and report of their transactions and accounts for the purpose of terminating their Trusteeship.

Upon termination, the Board of Trustees may transfer remaining Trust Fund assets, or any portion thereof, to the Trustees of any fund established for the purpose of providing substantially the same or greater benefits than those contemplated by this Plan. In no event shall any of the funds revert to or be recoverable by any employee, employer or union.

Unless sooner terminated, this Trust shall terminate upon the death of the last survivor of the persons entitled to benefits hereunder, provided, however, that if, as and when this Trust without the benefit of this provision will not violate the rule against perpetuities, then this provision shall be of no force or effect, and this Trust shall continue in perpetuity unless otherwise terminated.

Maternity Benefits
Under federal law group health plans may not restrict benefits for any hospital length of stay in connection with childbirth for the mother or the newborn child to less than 48 hours following a vaginal delivery or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the motherís or newbornís attending provider, after consulting with the mother, from discharging the mother or the newborn earlier than 48 hours (or 96 hours if applicable).

Certificate of Health Coverage
Under the Health Insurance Portability and Accountability Act (HIPAA), if your coverage under this plan stops, you and your covered dependents will receive a certificate that shows your period of coverage under the plan. You may need to furnish the certificate if you become eligible under another group health plan if it excludes coverage for certain medical conditions which exist before you enroll. You may also need the certificate to buy, for yourself or your family, an individual insurance policy that does not exclude coverage for medical conditions which exist before you enroll. You and your dependents may also request additional certificates within 24 months of losing coverage under this plan. Such request should be made to your Area Administrative Office.



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