Welcome

2. to the Sheet Metal Workers’ Health and Pension Plans of Southern CA, AZ & NV Welcome

3. The Administrative Office Office Hours: 7am to 5 pm Monday - Friday Mailing Address: P.O. Box 10067 Manhattan Beach, CA 90266 Phone: 800-94-SHEET or 310-798-6572 Fax: 310-798-0766

6. The Administrative Staff Administrator - Richard Wondra Asst. Administrator - Peggy Schack Accounting Department Claims Department Eligibility Department Pension Department Support Staff

7. The Accounting DepartmentDuane La Pointe, Controller Craig Wiseman, CPA, Supervisor Kathy Sowell Tasi Hernandez Kelly Sieverson Delia Munoz Jide Awelewa Joyce Liggins Donna Miller Tom Shinn • Receives and processes Employer Remittances(your hours worked)on a monthly basis

8. Your Hours Worked • Are due from your Employer by the 20th of the month following the actual work month • If your Employer reports your hours without the appropriate monies due, a completed “Declaration of Hours Worked” formis required from you before those hours will be credited to your Hour Bank

9. Keep your paycheck stubs! If there is a discrepancy in the hours that have been reported on your behalf - you may need to submit copies of your stubs to the Administrative Office for review.

10. The Pension Department Jack Rupert, ManagerValeria Hughes, SupervisorLouis Guerrero Jaime Medina • Processes Pension applications and Benefit checks based on contributions received from Employers for appropriate hours worked, as determined in the Collective Bargaining Agreement • Annual Pension Statements are mailed in May of each year, and indicate total hours reported

11. The Claims DepartmentPeggy Schack, ManagerShirley Jones, SupervisorIrene Medina,* Quality Assurance Auditor Vernell Anderson Kim Henderson B, G E, K, N, P, W Edna McQuirter Maria Martinez * C, H, L, O, T, U A, F, I ,M, S Maria Petracca * D, J, Q , R, V, X, Y, Z * Bilingual - Spanish

12. The Claims DepartmentPeggy Schack, ManagerShirley Jones, SupervisorIrene Medina,* Quality Assurance Auditor • Process all claims on the Fee-for-Service Medical and Dental plans • Acts as liaisons on behalf of participants with outside provider benefit issues.

13. The Support Staff John Mazariegos, Supervisor Leesa Noriega Rosie Mazariegos Eloise Corral Maynor Munoz Robert Bado Priscilla Velez Eddie Martinez • Mail room, files, supplies, etc • Assists other departments as needed “Behind the scenes” overall assistance

14. Computer Systems Andrea Amalfitano Computer Systems Administrator www. SheetMetalSam.org

15. The Eligibility DepartmentPatti A. Frank, ManagerAl Medina Pat Campbell Frank Lopez • Eligibility / Hour Bank status • Medical & Dental Plan Enrollments • Disability Extensions, Self-pay & COBRA • Communications / Member Service • Participant Data Maintenance

16. Your Eligibility for Benefits • Establishing • Maintaining • Continuing Determined by the Number of Hours You Work

17. Your Hours Worked • Are due from your Employer by the 20th of the month following the actual work month, and are used to determine eligibility for the following month • For example: Hours worked in January are due in our office by February 20th and determine March eligibility

18. Establishing EligibilityPlan B • Minimum of 100 hours each month for 2 consecutive months • One full calendar month wait • Eligibility begins on the 1st day of the next month.

19. Examples of Establishing EligibilityPlan B Work Month Hours or Hours January 100 90 February 120 160 March 100 120 Your Eligibility Begins: April 1 May 1

20. Maintaining Eligibility under Plan B • 100 hours worked = 1 month of eligibility • One full month in between actual hours worked and eligible month Example:Hours worked in January determine March eligibility

21. Continuing EligibilityYour Plan B Hour Bank • All hours worked go into your Hour Bank • Hour Bank can hold a maximum of : 200 hours (plus the current month) for Plan B • 100 hours are deducted from your bank on the first day of each month, for that month’s coverage

22. Transferring From Plan Bto Plan A • You must exhaust all of the hours in your Plan B hour bank before Plan A benefits will begin, and… • You must obtain at least 110 hours under Plan A two (2) months prior to your Plan A effective date.

23. Transferring From Plan Bto Plan A • As an Apprentice, your contributions from your Employer will be increased to Plan A. • Assuming a July, 2009 effective date of becoming an Apprentice, and you have a full Plan B Hour Bank of 200 Hours, your benefits under Plan A will become effective November 1, 2009.

24. Maintaining Eligibility under Plan A • 110 hours worked = 1 month of eligibility • One full month in between actual hours worked and eligible month Example:Hours worked in September determine November eligibility.

25. Continuing EligibilityYour Plan A Hour Bank • All hours worked go into your Hour Bank • Hour Bank can hold a maximum of : 880 hours (plus the current month) for Plan A • 110 hours are deducted from your bank on the first day of each month, for that month’s coverage

26. Unemployed or Disabled ? • 110 hour (100 for Plan B) per month deduction continues whether or not you are working • Extension may be available for those who are unable to work due to an injury or illness You are responsible for knowing the status of your hour bank, and when your coverage will terminate

27. Unable to Work due to a Disability? • Extension of benefits may be availableif you are unable to work for at least 7 consecutive days. • 27.5 (25 for Plan B) hours per week may be added to your Hour Bank, for a period of time you are disabled, to a maximum of 357.5 hours (325 for Plan B),or 13 weeks total. Completed Evidence of Coverage must be submitted to the Administrative Office within 30 days of the date of your disability.

28. Continuing Coverage while Unemployed or Disabled You may continue coverage on a self-pay basis by enrolling in either the : • Unemployed / Disabled Self-pay Plan(Plan A participants only), or • COBRA Continuation Coverage Once you have elected one of the above programs, you may not choose to enroll in the other.

29. Unemployed and Disabled Self-Pay Plans Reduced Benefits - Plan B • You must qualify & submit an application • Extension available for: • 12 consecutive months if unemployed, • 29 consecutive months if disabled • $250 month - Payment must be received in Administrative Office no later than the 20th of the monthprior to the month of coverage

30. COBRA Continuation Coverage • You will receive a COBRA Continuation Coverage Notification and Election Form within 10 days of your (or your dependent’s) loss of coverage. • Extension available: • 18 consecutive months for reduction of hours • 36 consecutive months for loss of dependent status

31. COBRA Continuation Coverage Plan A Benefits Current Monthly Rates as of 8/1/09 Medical, Dental & Vision Coverage Single Person $364.00 2-Party $728.00 Family $1,103.00

32. COBRA Continuation Coverage Plan B Benefits Current Monthly Rates as of 8/1/09 Medical, Dental & Vision Coverage Single Person $306.00 2-Party $612.00 Family $984.00

33. Reinstating Eligibilityunder Plan A • You must obtain at least 110 hours within 6 months of losing coverage • If more than 6 calendar months elapse, you must establish eligibility with 600 hours. Remember - there is one full month between work month and coverage month.

34. Establishing EligibilityPlan A • 600 hours for a Contributing Employer, in a period not to exceed 6 consecutive months. • One full calendar month wait • Eligibility begins on the 1st day of the next calendar month.

35. Examples of Establishing EligibilityPlan A Work Month Hours orHours January 110 155 February 120 155 March 80 170 April None 160 May 150 June 140 Your Eligibility Begins: August 1 June 1

36. Standard Notifications • New Eligible Benefit Packet • Reinstatement of Eligibility • Confirmation of receipt of Plan Enrollments & required dependent documentation • 440 & 220 hour “Threshold” letters - Plan A • Certificate of Coverage • COBRA

37. Your Eligible Dependents • Legal spouse • Children under 19 years of age • Students age 19 through 23 * • Handicapped children * Documentation which verifies relationship to the participant must be submitted to the Administrative Office. *Verification required

38. Documentation Required Copies of the following documents are required to add or delete dependents: • Spouse - Marriage Certificate • Children - Birth Certificate or Court Orders • Children between ages of 19 & 23 - • Full-time Student Verification (at least 12 units) • Ex-spouse -Divorce Decree

39. You must immediately notify the Administrative Office of any change in dependent status! If you do not notify us, and claims and/or premiums are paid on behalf of ineligible dependents, you will be held responsible for reimbursing the Plan for any and all monies paid in error, plus interest and attorney’s fees & costs.

40. Your Benefit Package • Major Medical(including prescription drugs) • Dental • Vision • Employee Assistance • Death Benefit

41. Your Medical Plan Options in NV • Fee-for-ServicePlan-Self-funded PlanYou may use any licensed physician, but it is to your advantage to use the PPO (Blue Cross) Network • Health Plan of Nevada-HMO Plan You must choose a Primary Care Physician (PCP) and use network providers • PacifiCare of Nevada- HMO Plan in Southern Nevada. You must choose a Primary Care Physician (PCP) and use network providers

42. Offers the flexibility of “choice”. You may see any licensed physician and use any facility you choose. Utilizing the PPO network (Preferred Provider Organization) greatly reduces your out-of-pocket expenses Claims for services incurred are processed and paid by the Administrative Office. The Fee-for-Service Plan Self-funded PPO Plan

43. Managed Care Environment No deductibles, lifetime maximums or claim forms Specified co-payments due at the time of service You (and your eligible dependents)must reside in your selected HMO’s defined service area, and have all services provided within their network You must select a Primary Care Physician (PCP), and see him/her for all services. If it is necessary to see a Specialist, your PCP will provide the referral The HMO Plans “Health Maintenance Organization”

44. Your Prescription Benefits Are determined by your Medical Plan • If you are enrolled on the Fee-for-Service Plan- • you must use the ExpressScripts program • If you are enrolled on an HMO- • you must use a participating HMO pharmacy

45. Your Dental Plan Optionsunder Plan B • Fee-for-Service Self-funded Indemnity Plan - You may use any licensed dentist. Benefits are paid based on scheduled allowable charges, as outlined in your Summary Plan Description. • United Concordia - You must select a United Concordia participating dentist, and have all dental services performed by that dentist

46. Your Dental Plan Optionsunder Plan A • Delta Dental Preferred Option - You may use any licensed dentist, but it is to your advantage to use a DPO network dentist, as his/her fees have been accepted in advance by Delta • United Concordia- You must select a United Concordia participating dentist, and have all dental services performed by that dentist.

47. Your Dental Plan Optionsunder Plan A • Delta Dental Preferred Option - If you are currently enrolled on the Fee-for-Service dental Plan under Plan B, you will automatically be enrolled on Delta Dental under Plan A. • United Concordia– If you are currently enrolled on United Concordia under Plan B, you will remain on United Concordia under Plan A.

48. Your Vision Benefits • Vision Service Plan No up front paperwork or forms required- Simply contact your participating VSP optometrist to make an appointment. If you need help locating a participating doctor, call VSP at: (800) VSP 7195(800-877-7195) or visit their website at vsp.com

49. Employee Assistance The Beat It! Program • If you are enrolled on the Fee-for-Service Medical Plan, you must use the Beat It! Program. • If you are enrolled on an HMO, you may choose between, or combine benefits available with your selected HMO. • For more information, call Beat It! at: 1-800-828-3939 100% Confidential !

50. Selecting Your Medical and Dental Plans You may select your plans - • within 60 days from your initial Eligibility date, or • during the Annual Open Enrollment Period If you do not select a Plan within the specified time-frame, you will automatically remain on the Fee-for-Service Medical or Dental Plans.