About the Health Plan
About the Plan
The Southern California Painting & Drywall Industries Health & Welfare Trust Fund is a Multi-Employer Health & Welfare plan which is administered by a Board of Trustees and funded by contributions from employers who are signatory to Collective Bargaining Agreement(s) with Southern California Painters and Allied Trades District Council #36. Half of the Trustees are representatives appointed by the Union and half are appointed by the Employers. The Trustees serve without pay as a service to the industry, the employees, and other beneficiaries participating in the Plan. The Trustees have the sole, full and exclusive discretionary authority to determine all questions regarding eligibility for benefits, to determine the nature and scope of benefits to be provided, to make rules and regulations necessary for the administration of the plan, and to construe the terms and provisions of the trust, and summary plan description. All such decisions, determinations and construction shall be final and binding on all parties. The Trustees have contracted the ministerial duties of administration of the plan’s benefits to
4399 Santa Anita Avenue
El Monte, CA 91731
Participating employers contribute into the Fund on either an hourly basis or a pre-determined monthly amount. These contribution rates are adjusted periodically depending on the financial status of the Fund. Contributions in excess of those required to pay benefits and administer the Plan are maintained in various income generating accounts until needed.
The Board of Trustees attempts to develop and maintain an overall program of benefits that can be purchased with the monies being received and that will be of value to all Plan participants and beneficiaries. The Board generally has no power to require employers to pay more money to the Trust to help the Trust maintain benefits at a particular level. Consequently, in order for the Board of Trustees to maintain responsible control over the financial condition of the Trust, the Board must constantly monitor and control the level of benefits being offered. The Board may, at any time, make changes in the type and amount of benefits provided under the Plan and in the eligibility requirements of the Plan. This may include, for example, increases or decreases in the number of hours that a participating employee is permitted to accumulate in an hour bank. It also may include the immediate elimination or addition of a type of benefit, increases or decreases in the amount of the deductible payment or in the percentage of charges covered, and, for participants enrolled in the HMO Plan, a change in benefits for that Plan or elimination or substitution of a current HMO. The Board of Trustees has and retains the right at any time to amend, change or eliminate any benefit under the Plan or the Plan itself. Such decision shall be solely in the discretion of the Trustees.
In order to ensure that all who benefit from the Plan do so appropriately and only as they are entitled, the Board of Trustees reserves the right and authority to impose upon employees and other participants and beneficiaries restrictions with respect to their future rights to receive benefits from the Trust. The Trustees also reserve the right to refuse payment for services rendered or facilities or supplies furnished by particular health care providers. These powers may be used as the Trustees deem necessary as, for example, when the Trustees determine that an employee or other participant or beneficiary or health care provider has made any misrepresentation (whether or not intentional) in connection with claims for benefits or has committed any act or omission resulting in abuse or misuse of the Plan. The Trustees further reserve the right to deduct from benefits that would normally be paid for later claims the amount of any benefit incorrectly paid or not reimbursed to the Trust when reimbursement is required. Finally, the Trustees reserve the right to seek reimbursement and other damages, together with attorney’s fees (to the extent provided by law) and other costs incurred in connection with recovering any benefits incorrectly paid, or not reimbursed when reimbursement is required under the Plan.
Also, at this time certain benefits are provided on an insured basis. The Plan contracts for pre-paid medical benefits through certain Health Maintenance Organizations (HMOs). These HMOs currently are Kaiser and Aetna. The Plan also insures on a pre-paid basis the Dental benefits offered through the Trust. These benefits are provided by Delta Dental, Inc.
Prescription benefits are administered by Optum Rx, or for Kaiser members, provided on a pre-paid basis directly by Kaiser. Utilization Review and Pre-Admission Review services are provided by Anthem Blue Cross. Large claim indemnity stop-loss insurance is purchased from Swiss Reinsurance Corporation. This insurance pays certain medical claims that are in excess of the Plan’s self-insured Indemnity PPO Plan claim retention.
The Health Fund contracts with Anthem Blue Cross of California for its Prudent Buyer Network which includes hospitals, physicians, laboratories, x-ray facilities and ancillary services. If you use a Prudent Buyer Provider, you will be afforded quality health care, save money, and the Health Trust will save money. For help in locating Prudent Buyer Providers, consult your Blue Cross Prudent Buyer Directory, go to the Anthem Blue Cross website www.anthem.com or contact the Trust Fund Office at 1-800-752-2394.
Be advised that even if a certain provider is included in the directory, that provider may no longer be contracted with the Anthem Blue Cross PPO Network, or the particular services of that provider may not be covered by the Trust Fund’s plan of benefits. It is up to each Plan participant to call their providers to verify they are currently a member of the PPO network before utilizing their services, and to check with the Trust Administrative Office to confirm what benefits are covered or excluded by the Plan, otherwise it may cost you more in out-of-pocket expenses.
The Plan Administrator is the Board of Trustees of the Southern California Painting & Drywall Industries Health & Welfare Trust Fund, a joint board of Trustees composed of an equal number of labor and management trustees. The administration of the Plan is handled through an Administrative Manager who can be contacted at the following address and phone number:
Pacific Southwest Administrators
4399 Santa Anita Ave, Suite 150
El Monte, CA 91731
Type of Plan:
Health & Welfare Plan.
January 1 through December 31
IRS Employer ID Number:
Melissa W. Cook & Associates
3444 Camino Del Rio North, Ste. 106
San Diego, CA 92108
Monthly contributions are made by each employer and are transmitted to the Trust Department of UBOC, which serves as Fund Custodian for the Trust Fund. Total contributions are held by Union Bank in a checking lockbox out of which premium payments are made to the carriers that provide benefits as directed by the Administrator. Funds in excess of those needed for immediate requirement are invested at the direction of Wurts and Associates on behalf of the Trustees in short-term investments.
Collective Bargaining Agreements:
Contributions to the Plan are made on behalf of each Active Employee in accordance with Collective Bargaining Agreements between the Union and employers in the industry or Non-Bargaining Participation Agreements. The Administrative Office will provide you, upon request, with a copy of the applicable Collective Bargaining Agreement. You will be charged a reasonable amount for copying. Additionally, upon written request, the Administrative Office will provide you with information on whether a particular employer or employee organization is a sponsor of the Plan and the employer or employee organization’s address.
Southern California Painters and Allied Trades District Council 36
1155 Corporate Center Drive
Monterey Park, California 91754
Agent for Service of Legal Process:
Melissa W. Cook
3444 Camino Del Rio North, Ste. 106
San Diego, CA 92108
Legal Process may also be served on any Trustee or the Trust Fund Office.