Get to Know Your Summary Plan Description (SPD)
By: Candice Stark
When you are enrolled for benefits in the NOITU Insurance Trust Fund (the “Fund”), you will receive a white three-ring binder, whose cover boldly says “Summary Plan Description of Your Health Benefits” (SPD). The benefits to which you are entitled were negotiated in the Collective Bargaining Agreement (CBA) between your Employer and the Union (NOITU). These benefits are described in detail in the SPD.
Why is it important to read my SPD and learn about my benefits?
Preventive care – In order to maintain your health and well-being, it is important to make the time to see your doctor(s) for checkups and follow-ups as needed. In most cases, being proactive about your health can prevent or decrease the severity of many illnesses and conditions. Your SPD will let you know what type of coverage you have and how to obtain it. It will help you to maximize your benefits and avoid unnecessary out-of-pocket expenses.
Emergency care – As you know, at a time of crisis, you cannot stop to read your SPD to find out how to use your benefits. It is important to learn about your benefits before an emergency exists to know what is and what is not covered, and to help avoid unnecessary out-of-pocket expenses.
What type of information can I learn from my SPD?
You can obtain answers to questions such as the following:
- What are my benefits?
- What benefits are not covered (excluded)?
- If my spouse and children are entitled to coverage, how do I enroll them?
- Can I add dependents? If so, how and when?
- What is a pre-existing condition?
- How do my medical and/or dental visits get paid?
- What happens if my claim gets denied? What are my options?
- If my spouse has medical coverage in addition to my medical coverage, whose insurance pays for the medical visits of my family?
- What if my doctor or hospital visit is the result of an accident?
- What is COBRA? HIPAA? FMLA? ERISA?
As you get to know your SPD, you will gradually feel more comfortable about your benefits. You also have qualified member services staff available to assist you with your questions about your benefits weekdays between the hours of 9:00am and 5:00pm. All you have to do is call 718-291-3434, option 3. Your health and well-being are of the utmost importance to us!
