Carpenters Local 308 - Schedule of Benefits

Local #308 of the United Brotherhood of Carpenters & Joiners of America

Schedule of Benefits

United Brotherhood of Carpenters and Joiners of America

For You as an Eligible Employee and Your Eligible Dependents

Health, Dental & Vision Benefits

Your Trustees have negotiated lower medical costs with the Cedar Rapids Physicians Hospital Organization (PHO) and the Priority Health Network (PHN). What this means is that your benefits under the Fund's health plan are greater and your out-of-pocket cost is less when you use: 1). the PHO or PHN's doctors and hospital "in-network" rather than, 2). if you use non-PHO/PHN doctors and hospitals. You will be notified about additional PHOs and/or networks in other geographic areas, as we add them to our plan of benefits.

	Network	Non-Network
Deductible	PHO or PHN Participating Doctors and Hospitals	Non-PHO or PHN Participating Doctors and Hospitals
Your Co-Payment (You Pay)	10% up to $250 / individual out of pocket expense (See note below)	Your deductible + 20% co-pay up to $1000 / individual out of pocket expense , + all charges over "Usual, Reasonable & Customary"
Plan Pays	90% up to $2,500 in charges, then 100%	80% of "Usual, Reasonable & Customary" up to $5,000 then 100% "Usual, Reasonable & Customary"
Pharmaceutical (Rx) Benefits	NO Deductible Covered at 90%	$100 individual/$200 family, deductible applies, then covered at 80% of "Usual, Reasonable & Customary"
Hospital Emergency Room	Between 8pm & 8am weekdays, and Saturdays, Sundays & Doctor's Holidays: no deductible, no co-payment, otherwise subject to deductible and co-payments above	Subject to deductible and co-payments above
Ambulance	Subject to deductible and co-payments above (Services include local ambulance services, air ambulance, transportation within the US by non-air ambulance or on a regularly scheduled flight on a commericial airline when transportation is medically necessary).
Lifetime Max.	$1,000,000
Treatment of Mental or Nervous Disorders	Fund pays 50% of covered services up to a lifetime maximum of 30 days in-patient car or 100 days of out-patient care (mutually exclusive limits) for each covered individual.
Treatment of Alcohol & Drug Abuse	Fund pays 50% of covered services up to a lifetime maximum of 90 days of care for each covered individual.
Dental	Fund pays 100% of covered services up to $300 per covered individual each calender year.
Vision	Fund pays 100% of covered services up to $200 per covered individual each TWO calender year period (The first "Two calender year" period is Jan. 1, 1998 through Dec. 31, 1999.

NOTE: Certain hospitals and doctors' organizations have entered into a price stabilization agreement with your trustees. For members and their dependants who use these designated doctors and in-network hospitals, there will be NO DEDUCTIBLE and A VERY LIMITED CO-PAYMENT (Max. $250 out of pocket) required for the applicable doctors and/or in-network hospital charges. A letter can be obtained with the names of these in-network doctors and hospitals.
For non-network doctor visits and/or use of non-network hospitals, a $100 individual/$200 family deductible (per calender year) and a different co-payment applies.

For You as an Eligible Active Employee

Life Insurance .................................................$5,000
Accidental Death & Dismemberment Benefits .....$5,000
(United of Omaha)
Accidental Death & Dismemberment Benefits ....$30,000
(Mutual of Omaha)
Accident & Sickness Disability Benefits ..........$250/week
(United of Omaha)

Commencing the 1st day of disability due to injury and the 8th day of disability due to illness; benefits payable up to 26 weeks for any one period of disability; see page 34 of "Group Benefits Program" for information on where and how to file a claim for benefits.

For Your Eligible Dependents

Life Insurance

Spouse ................................................................... $2,000
Unmarried Child less than 6 months old ............................. $100
Unmarried Child 6 months but less than 19 years old *....... $2,000

*Unmarried Children ages 19-23 also covered if attending school full time.