Transparency & Coverage Rules

Anthem – Machine Readable Files

Effective July 1, 2022, based on the U.S. Departments of Health and Human Services, Labor, and Treasury” rule on Transparency in Coverage rules we are mandated to publish machine readable files (MRFs) related to health plan coverage so that consumers/members can see negotiated rates between service providers and third-party payors including out of network allowed amounts.

Below is the link to access the files reflecting standard format and information related to the Anthem ESO plan. Please enter the New England Healthcare Employee Fund EIN number 06-1188411 to access the files.

Any questions, feel free to call the fund office at 860-728-1100 or Toll Free at 800-227-4744.

Anthem Machine Readable File Search

Pension Fund Highlights

Overview

What is the New England Health Care Employees Pension Fund?

The New England Health Care Employees Pension Fund is a Taft-Hartley defined benefit plan. The plan is administered by an equal number of management and union trustees who make up the Board of Trustees. Your benefit is defined by a formula which is based on your years of credited service and earnings during a specified period of time before you retire.

Participation in the Plan

How do I become a participant?

There are two requirements to become a participant of the Pension Plan

You are in a covered job class with a contributing employer under an 1199 Collective Bargaining Agreement (CBA)
Your employer is required to contribute to the Fund on your behalf under the terms of the CBA.

Vesting

Vesting Service – You earn one year of vesting credit if you work at least 1,000 hours in a calendar year for a contributing employer

Earning and Calculating Your Pension Benefit

Your pension benefit is determined by a formula that takes the sum of your earned Credited Future Service and your average earnings.

Credited Future Service – Each month that you work the required number of hours per the CBA your Employer will make a contribution on your behalf. Each contribution will earn you a credit for that month (.0833 of credited service per monthly contribution)

Average Earnings – The average of your highest five consecutive years of wages within a ten-year time frame in which you received a future service credit. The plan takes your highest five consecutive years of wages, divides them by the number of months that a contribution was received, and multiplies them by 12
- i.e., Total Wages in a five-year period = $171,593.27; total number months that a contribution was received = 59 months.
  - $171,593.27 / 59 = $2,908.36 x 12 = $34,900.32 (your average earnings)

Pension Benefit Percentage Rate – A percentage that is determined by the Board of Trustees

Below is the formula that is used to determine your pension benefit:

Average Earnings x Total Credited Future Service x Pension Benefit Percentage Rate / 12= Your monthly pension benefit

Becoming 100% Vested in the Plan

You become entitled to your pension benefit when you become 100% vested. You must meet one of the following requirements (plus have one additional month of credited future service) to become vested:

5 Years of Vesting Service (five years of 1000 hours or more) or
5 Years of Credited Future Service (60 future service credits) or
Any combination of 5 calendar Years of Credited Service and Years of Vesting Service (the same period shall never be counted twice)

Pension Fund Questions and Answers

Pension Fund Questions and Answers

How do I enroll in the Pension Fund?

You need to complete an enrollment form. Mail the completed form to:

1199 New England Health Care Employees Pension Fund
77 Huyshope Avenue, 2nd Floor
Hartford, CT 06106-7001

What is a covered job class?

Any position listed in your Collective Bargaining Agreement (CBA), Recognition section (usually listed in Article 1 or the Preface of the CBA).

Who makes contributions to the pension plan?

Contributions are paid entirely by your Employer on your behalf on a monthly basis based on overall employee payroll. Your Union dues do NOT go toward your pension, nor are any deductions taken from your paychecks for pension contributions. Your employer is required to contribute on your behalf when you work the required number of hours in a month as outlined in your CBA.

How do I become vested?

You earn one year of vesting service if you work 1,000 or more hours in a calendar year. You need 5 vesting credits plus at least one (1) additional employer contribution to be 100% vested in the Plan.

Please refer to the Summary Plan Description (SPD) for additional ways to fully vest in the plan.

Do I need to name a beneficiary?

If you are married your spouse is automatically your beneficiary.

If you are single, you do not automatically have a beneficiary for your pension. When you apply for your pension benefit you can elect an option to name a beneficiary.

What if I die before I retire?

If you are married; your spouse is automatically entitled to a 50% Joint & Survivor (J&S) benefit (unless you have chosen a different option with the written consent of your spouse).
Under the J&S benefit, if you die after age 55 your spouse can collect immediately or delay to when you would have reached age 65.
Under the J&S benefit, if you die before age 55 the earliest your spouse can begin collecting a benefit is when you would have reached age 55. Your spouse will receive these payments for life.

What happens if I transfer to or from a bargaining position to a non-bargaining position?

If you are vested in the Plan before you transfer, you are entitled to your vested benefit at retirement.
If you are not vested in the Plan before you transfer, you may still be entitled to (1) vesting credit if you work at least 1,000 hours in that calendar year.
You will not receive any benefit credits while in a non-bargaining position.
You may not collect your pension while in a non-bargaining position with a contributing employer.

Are loans or hardship withdrawals allowed?

No, there are no provisions for loans or withdrawals.

Can I take a lump sum distribution?

No, the pension benefit is only payable as a monthly benefit.

When can I retire?

If you are 100% vested, you can:

Early retire any time after age 55. If you early retire your pension is subject to a 6% reduction per year (i.e.: 60% reduction at age 55; 30% reduction at age 60; 6% reduction at age 64)
Normal retirement age is 65 with no reduction.

What is an Unreduced Early Retirement?

You must complete 10 years of credited future service and must work in a covered job class for the 10 years immediately preceding your Early Retirement Date and

You must also meet one of the following requirements:

You are age 55 and the sum of your age and years of credited service, vesting service, or combination of both equals at least 90
You are age 62 and have completed 25 years of credited service, vesting service or any combination of the two

Is my pension benefit taxable?

Yes, your pension benefit is considered a taxable source of income. You will receive tax forms to complete when you apply for your benefit.

Can pension benefits or eligibility criteria change?

Yes, in accordance with applicable federal law, the Pension Fund Trustees are allowed, and under certain circumstances are required, to make changes to benefits and qualifying criteria in their capacity as fiduciaries to the Pension Fund. If you are potentially effected by any changes adopted by the Trustees, you will receive notice of any benefit reductions prior to the implementation of these changes by the Pension Fund.

Please note the purpose of this Q and A is to provide informal guidance only and that all elements of the Pension Fund are controlled by the terms of the Fund Plan Document and SPD

Who should I contact if I have additional questions?

Send an email to pension@1199nefunds.org
Website: 1199 New England Health Care Pension Fund
Telephone 860-728-1100 or 800-227-4744 and select option 7
Mailing address:

77 Huyshope Avenue, 2^nd Floor Hartford, CT 06106

Where can I get additional information about the Pension Plan?

Please visit our website www.1199nefunds.org and click the Pension Fund link. Under Pension Fund Forms click on the Pension Fund Summary Plan

Change of Address Form

Notice of Privacy – Welfare Fund

NOTICE OF NEW ENGLAND HEALTH CARE EMPLOYEES

WELFARE FUND PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW THE FUND’S MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

USE AND DISCLOSURE OF HEALTH INFORMATION

The Welfare Fund may use your health information, that is, information that constitutes protected health information as defined in the Privacy Rule of the Administrative Simplification provision of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), for purposes of making or obtaining payment for your care and conducting its health care operations. The Welfare Fund has established a policy to guard against unnecessary or inappropriate disclosure of your health information.

THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH, YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED:

To Make or Obtain Payment. The Welfare Fund may use or disclose your health information to make payment to or collect payment from third parties, such as other health plans or providers, for the care you receive. For example, the Welfare Fund may provide information regarding your coverage or health care treatment to other health plans to coordinate payment of benefits.

To Conduct Health Care Operations. The Welfare Fund may use or disclose health information for its own operations and administration and as necessary to provide coverage and services to all of the Welfare Fund’s participants. Health care operations includes such activities as:

Quality assessment and improvement activities.
Activities designed to improve health or reduce health care costs.
Clinical guideline and protocol development, case management and care coordination.
Contacting health care providers and participants with information about treatment alternatives and other related functions.
Health care professional competence or qualifications review and performance evaluation.
Accreditation, certification, licensing or credentialing activities.
Functions to create, renew or replace health insurance or health benefits.
Review and auditing, including compliance reviews, medical reviews, legal services and compliance programs.
Business planning and development including cost management and planning related analyses and formulary development.
Business management and general administrative activities of the Welfare Fund, including participant service and resolution of internal grievances.
To make eligibility determinations, conduct case management, quality improvement and utilization review, and provider credentialing activities or to engage in customer service and grievance resolution activities.

Disclosure to the New England Health Care Employees Pension Fund. The Welfare Fund may disclose your health information to the New England Health Care Employees Pension Fund to enable the Pension Fund to make eligibility determinations if you apply for a Pension Fund benefit.

For Treatment Alternatives. The Welfare Fund may use and disclose your health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

For Distribution of Health-Related Benefits and Services. The Welfare Fund may use or disclose your health information to provide to you information on health-related benefits and services that may be of interest to you.

For Disclosure to the Plan Sponsor. The Welfare Fund may disclose your health information for plan administration functions. The Welfare Fund also may provide summary health information to solicit premium bids from other health plans or modify, amend or terminate the plan.

For Resolving Liens, Subrogation Claims. The Welfare Fund may use or disclose your health information to your legal representative in order to resolve Fund liens in third party liability cases.

When Legally Required. The Welfare Fund will disclose your health information when it is required to do so by any federal, state or local law.

To Conduct Health Oversight Activities. The Welfare Fund may disclose your health information to a health oversight agency for authorized activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. The Welfare Fund, however, may not disclose your health information if you are the subject of an investigation and the investigation does not arise out of or is not directly related to your receipt of health care or public benefits.

In Connection With Judicial and Administrative Proceedings. As permitted or required by state law, the Welfare Fund may disclose your health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a subpoena, discovery request or other lawful process, but only after the Welfare Fund makes reasonable efforts to notify you about the request.

For Law Enforcement Purposes. As permitted or required by state law, the Welfare Fund may disclose your health information to a law enforcement official for certain law enforcement purposes.

In the Event of a Serious Threat to Health or Safety. The Welfare Fund may, consistent with applicable law and ethical standards of conduct, disclose your health information if the Fund, in good faith, believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public.

For Specified Government Functions. In certain circumstances, federal regulations require the Welfare Fund to use or disclose your health information to facilitate specified government functions related to the military and veterans, national security and intelligence activities and protective services for the president and others.

For Worker’s Compensation. The Welfare Fund may release your health information to the extent necessary to comply with laws related to Worker’s Compensation or similar programs.

AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION

Other than as stated above, the Welfare Fund will not disclose your health information other than with your written authorization. If you authorize the Welfare Fund to use or disclose your health information, you may revoke that authorization in writing at any time.

YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION

You have the following rights regarding your health information that the Welfare Fund maintains:

Right to Request Restrictions. You may request restrictions on certain uses and disclosures of your health information. You have the right to request a limit on the Welfare Fund disclosure of your health information to someone involved in the payment of your care. However, the Welfare Fund is not required to agree to your request. If you wish to make a request for restrictions, please contact the Welfare Fund Privacy Officer at 1-800-227-4744 and ask to have the Request For Restrictions on Use and/or Disclosure of PHI Form sent to you. Fill out the form and send the form to the Welfare Fund Privacy Officer, 77 Huyshope Avenue 2^nd Floor, Hartford, CT 06106-7001 (fax number is 860-947-8080). The Welfare Fund will attempt to honor your reasonable requests for restrictions on disclosures of your health information.

Right to Receive Confidential Communications. You have the right to request that the Welfare Fund communicate with you in a specified manner if you feel the disclosure of your health information could endanger you. For example, you may ask that the Welfare Fund only communicate with you at a certain address, telephone number or by email. If you wish to receive confidential communications, please call the Welfare Fund and ask to have the Participant Request For Confidential Communication Form sent to you. Fill out the form and send the form to the Welfare Fund Privacy Officer, 77 Huyshope Avenue 2^nd Floor, Hartford, CT 06106-7001 (fax number is 860-947-8080). The Welfare Fund will attempt to honor your reasonable requests for confidential communications.

Right to Inspect and Copy Your Health Information. You have the right to inspect and copy your health information. If you wish to request access to your protected health information, please call the Welfare Fund and ask to have the Request For Access to Protected Information Form sent to you. Fill out the form and send the form back to the Welfare Fund Privacy Officer, 77 Huyshope Avenue 2^nd Floor, Hartford, CT 06106-7001 (fax number is 860-947-8080). If you request a copy of your health information, the Welfare Fund may charge a reasonable fee for copying, assembling costs and postage, if applicable, associated with your request.

Right to Amend Your Health Information. If you believe that your health information records are inaccurate or incomplete, you may request that the Welfare Fund amend or supplement the records. Your request may be made as long as the information is maintained by the Welfare Fund. If you wish to amend or correct your protected health information, please call the Welfare Fund and ask to have the Request For Amendment/Correction of Protected Information Form sent to you. Fill out the form and send the form back to the Welfare Fund Privacy Officer, 77 Huyshope Avenue 2^nd Floor, Hartford, CT 06106-7001( fax number is 860-947-8080). The Welfare Fund may deny the request if it does not include a reason to support your proposed correction or amendment. The request also may be denied if your health information records were not created by the Welfare Fund, if the health information you are requesting to amend is not part of the Welfare Fund records, if the health information you wish to amend falls within an exception to the health information you are permitted to inspect and copy, or if the Welfare Fund determines that the records containing your health information are accurate and complete.

Right to an Accounting. You have the right to request a list of disclosures of your health information made by the Welfare Fund for any reason other than for treatment, payment or health operations. If you wish to request disclosures of your protected health information, please call the Welfare Fund and ask to have the Request For An Accounting of Disclosures Form sent to you. Fill out the form and send the form back to the Welfare Fund Privacy Officer, 77 Huyshope Avenue 2^nd Floor, Hartford, CT 06106-7001 (fax number is 860-947-8080). The request should specify the time period for which you are requesting the information, but in no event earlier than April 14, 2006. Accounting requests may not be made for periods of time going back more than six (6) years, but in no event earlier than April 14, 2006. The Welfare Fund will provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee. The Welfare Fund will inform you in advance of the fee, if applicable.

Right to a Paper Copy of this Notice. You have a right to request and receive a paper copy of this Notice at any time, even if you have received this Notice previously or agreed to receive the Notice electronically. To obtain a paper copy, please contact Welfare Fund Privacy Officer, 77 Huyshope Avenue 2^nd Floor, Hartford, CT 06106-7001 (fax number is 860-947-8080).

DUTIES OF THE WELFARE FUND

The Welfare Fund is required by law to maintain the privacy of your health information as set forth in this Notice and to provide you this Notice of its privacy practices and policies. The Welfare Fund is required to abide by the terms of this Notice, which may be amended from time to time.

The Welfare Fund reserves the right to change the terms of this Notice and to make the new Notice provisions effective for all health information that it maintains. If the Welfare Fund changes its policies and procedures, the Fund will revise the Notice and will provide a copy of the revised Notice to you within 60 days of the change.

You have the right to file complaints with the Welfare Fund and with the Secretary of the Department of Health and Human Services if you believe that your privacy rights have been violated. Any complaints to the Welfare Fund should be made in writing to the Welfare Fund Privacy Officer, 77 Huyshope Avenue 2^nd Floor, Hartford, CT 06106-7001 (fax number is 860-947-8080). The Welfare Fund encourages you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.

Complaints filed directly with the Secretary must be made in writing to the Secretary of the Department of Health and Human Services, 200 Independence Avenue, S.W.; Washington, DC 20201. The letter must name the entity against whom the complaint is lodged, must describe the acts or omissions complained of and must be filed within 180 days of the time you became aware of the violation.

CONTACT PERSON

The Welfare Fund has designated the Welfare Fund Privacy Officer as its contact person for all issues regarding participant privacy and your privacy rights. You may contact this person at 77 Huyshope Avenue 2^nd Floor, Hartford, CT 06106-7001. The telephone number is

1-800-227-4744.

EFFECTIVE DATE

This Notice is effective December 1, 2017.

If you have any questions regarding this notice, contact the Welfare Fund Privacy Officer, 77 Huyshope Avenue 2^nd Floor, Hartford, CT 06106-7001. The telephone number is 860-227-4744.

Coronavirus Update

As part of our continuing efforts to address the COVID-19 virus outbreak, we are no longer providing in-person services for participants at our Fund Office until further notice. While we recognize and appreciate the impact this may cause, we feel we must do what is best for the safety and health of our office staff and participants during this unprecedented crisis. Our staff remains available to assist by phone, mail and online services.

We can be reached at (860)728-1100 or (800)227-4744 or our email address is membership@1199nefunds.org Monday – Friday 9am- 5pm