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To: All Participants in the Equity-League Pension Plan

From: Arthur Drechsler, Executive Director

Re: Changes to the Equity-League Pension Plan

Date: October 11, 2001

This document is a Summary of Material Modifications (“Summary”) intended to notify you of important changes made to the Equity-League Pension Plan (“the Plan”) during the Plan Year beginning on June 1, 2000 and ending on May 31, 2001. You should take the time to read this Summary carefully and keep it with the copy of the Summary Plan Description that was previously provided to you. If you need another copy of the Summary Plan Description or if you have any questions regarding these changes to the Plan, please contact the Fund Office during normal business hours at 165 West 46th Street, 4th Floor New York, NY 10036-2582, telephone number (212) 869-9380 or visit our website at www.equityleague.org.

· On October 5, 2000, the Board of Trustees of the Plan adopted the following material modification to the Plan:

Effective January 1, 1999, the Board of Trustees voted to eliminate the earnings restriction for those participants who retire, commence payments of their benefits from the Fund, and then subsequently return to work in Covered Employment. As a result of this change, a Pensioner may work in Covered Employment and continue to receive his or her benefits, regardless of earnings. A Pensioner who returns to work and has earnings in Covered Employment shall have his pension recomputed to take into account any additional Covered Earnings which shall become payable as of the next January 1st. Finally, employed Pensioners who continue to receive benefits shall also be entitled to any Plan benefit increases granted to Pensioners that may be adopted while they are reemployed.

· On January 25, 2001, the Board of Trustees voted to expand the 15% benefit increase to Pensioners, adopted at the May 1, 2000 meeting, to include Pensioners who became Pensioners between January 1, 1998 and May 1, 2000, in addition to those who became Pensioners prior to January 1, 1998.


* * * * *

This Summary is intended to provide you with an easy-to-understand description of certain changes to the Plan. While every effort has been made to make this description as complete and as accurate as possible, this Summary, of course, cannot contain a full restatement of the terms and provisions of the Plan. If any conflict should arise between this Summary and the Plan, or if any point is not discussed in this Summary or is only partially discussed, the terms of the Plan will govern in all cases. The Board of Trustees or its duly authorized designee, reserves the right, in its sole and absolute discretion, to amend, modify or terminate the Plan, or any benefits provided under the Plan, in whole or in part, at any time and for any reason, in accordance with the applicable amendment procedures established under the Plan and the Agreement and Declaration of Trust establishing the Plan (the "Trust Agreement"). The Trust Agreement is available at the Fund Office and may be inspected by you free of charge during normal business hours.No individual other than the Board of Trustees (or its duly authorized designee) has any authority to interpret the plan documents, make any promises to you about benefits under the Plan, or to change any provision of the Plan. Only the Board of Trustees (or its duly authorized designee) has the exclusive right and power, in its sole and absolute discretion, to interpret the terms of the Plan and decide all matters arising under the Plan.



SUMMARY OF MATERIAL MODIFICATIONS TO THE EQUITY-LEAGUE HEALTH TRUST FUND

(Effective January 1, 2002)

To: All Participants in the Equity-League Health Trust Fund

From: Board of Trustees

Re: Changes to the Fund’s Claims Procedures for Supplemental Workers’ Compensation Benefits

This document is a Summary of Material Modifications ("SMM") intended to notify you of important changes made to the Equity-League Health Trust Fund (the “Fund”), which will be in effect for claims filed on or after January 1, 2002, in accordance with recent changes to applicable legal requirements.

You should take the time to read this document carefully and keep it with your copy of the Fund’s Summary Plan Description ("Summary"). This document replaces the provisions in the Summary relating to denials of claims for Supplemental Workers’ Compensation Benefits and appeals of denied claims. The Summary provisions regarding claim denials and appeals for other types of benefits provided under the Fund (for example, claims for medical benefits) remain unchanged at this time. In addition, the language in the Summary regarding to how file a claim for Weekly Loss of Time benefits remains the same.

If you need another copy of the Summary or if you have any questions regarding these changes, please contact the Fund Office during normal business hours at [insert address and telephone number of Fund Office].

* * *

Effective for claims filed on or after January 1, 2002, the Fund’s Board of Trustees has adopted the following changes to the Fund’s procedures regarding claims for Supplemental Workers’ Compensation Benefits (see page 33 of the Summary) and appeals of “adverse benefit determinations.” These procedures apply to all “adverse benefit determinations,” which include claim denials, reductions or terminations of benefits, and failures to make payment (in whole or in part) for a benefit, including determinations that are based on decisions relating to a participant’s or beneficiary’s eligibility to participate in the Fund.

SUPPLEMENTAL WORKERS’ COMPENSATION BENEFITS - - CLAIMS AND APPEALS PROCEDURES

Initial Claim Determinations


If your claim for Supplemental Workers’ Compensation Benefits (referred to as “Weekly Loss of Time Benefits”) is wholly or partially denied by the Fund, you will be notified of the Fund’s benefit determination within 45 days after your claim was received by the Fund. If the Fund Manager determines that an extension of time is necessary for processing your claim (due to circumstances beyond the control of the Fund), the 45-day period may be extended for up to an additional 30 days and, if additional time is still needed after that period ends, there may be one more extension of an additional 30 days. If an extension is needed, you will be notified (within the initial 45-day period) of the circumstances requiring the extension and the date by which a decision is expected to be made. The notice will inform you of the standards for entitlement to Weekly Loss of Time Benefits and the issues that are delaying a decision on your claim, as well as the additional information needed to resolve those issues. You will have 45 days to provide the Fund with the requested information.

If the Fund makes an “adverse benefit determination” with regard to your claim for Weekly Loss of Time Benefits, you will be provided with written notification including:

• the specific reasons for the Fund’s determination and references to the specific Summary provisions on which the determination is based,

• a description of any additional material or information needed to complete your claim (including an explanation of why the information is needed),

• a description of the Fund’s appeal procedure and applicable time limits, as well as a statement of your right to bring suit under federal law (Section 502(a) of ERISA) following an adverse determination on appeal,

• a statement that you have the right to submit written comments, documents, records and other information relating to the claim, and that, upon your request, the Fund will make available to you (or provide you with copies of) all documents, records and other information relevant to your claim,

• a description of any internal rule, guideline or similar standard that the Fund relied on in making the decision, or a statement that the rule, guideline or standard was relied on and that a copy will be provided to you (without charge) upon your request,

• a description of any scientific or clinical judgment that the Fund relied on in making a decision based on medical necessity, experimental treatment or a similar limitation, or a statement that such explanation will be provided (without charge) upon your request, and

• the name of any medical or vocational expert whose advice was obtained by the Fund in connection with your claim.

Appeals of Adverse Benefit Determinations

You (or your authorized representative) may appeal the Fund’s adverse benefit determination in writing to the Fund’s Board of Trustees within 180 days after you receive notice of the determination. (Prior to January 1, 2002, you had only 60 days to appeal such a decision.)

You (or your authorized representative) may submit written comments, documents, records and other information relating to the claim in support of your appeal. In considering your appeal, the Board of Trustees will review all information that you submit, even if it was not submitted or considered in the initial benefit determination made by the Fund. In addition, upon your written request, the Fund will provide you (or your authorized representative) with access to, or copies of, all documents, records and other information relevant to your claim.

If the initial decision on your claim for Weekly Loss of Time Benefits was based (in whole or in part) on a medical judgment, in deciding your appeal, the Board of Trustees will consult with a health care professional who has training and experience in the relevant field of medicine and who is not the same person as the individual consulted by the Fund in making the initial decision on your claim (or subordinate to that person).

The Board of Trustees will review your appeal during its next regularly scheduled meeting, provided that your appeal is received by the Fund Office at least 30 days before the meeting date. If your appeal is received by the Fund Office less than 30 days before the next regularly scheduled meeting of the Board of Trustees, your appeal will be reviewed at the second regularly scheduled meeting following the Fund’s receipt of your appeal. If special circumstances require an extension of time for processing your appeal, then the Trustees will make a decision on your appeal during the third regularly scheduled meeting following receipt of your appeal. If this extension is needed, you will be notified in writing (before the extension begins) of the circumstances requiring the extension and the date as of which the appeal determination will be made.

You will be notified in writing of the Board’s decision on your appeal within 5 days after the decision is made. If your appeal is denied, the written notice will include all of the information described above (in the section regarding notice of initial claim determinations), as well as a statement regarding the availability of other voluntary alternative dispute resolution options.

* * *

All decisions of the Board of Trustees are final and binding on all parties.

If you have any questions about these new procedures, please contact the Fund Office.

This document is intended to provide you with an easy-to-understand description of certain changes to the Fund’s plan of benefits. The Board of Trustees reserves the right, in its sole and absolute discretion, to amend, modify or terminate these procedures or any other provision in the Fund’s benefit plan, in whole or in part, at any time and for any reason, in accordance with the applicable amendment procedures established under the Fund and the Agreement and Declaration of Trust establishing the Fund. No individual other than the Board of Trustees (or its duly authorized designee) has any authority to interpret the Summary or any other plan documents (including this document), to make any promises to you about benefits under the plan, or to change any provision of the plan. Only the Board of Trustees (or its duly authorized designee) has the exclusive right and power, in its sole and absolute discretion, to interpret the terms of the Fund’s plan (with regard to both legal and factual issues) and to decide all matters arising under the plan.



SUMMARY OF MATERIAL MODIFICATIONS TO THE EQUITY-LEAGUE HEALTH PLAN

To: All Participants in the Equity-League Health Trust Fund

From: Arthur Drechsler, Executive Director

Re: Changes to the Equity-League Health Trust Fund

Date: September 28, 2000

This document is a Notice of Changes ("Notice") intended to notify you of important changes made to the Equity-League Health Trust Fund ("the Plan") during the Plan Year beginning on June 1, 1999 and ending on May 31, 2000. You should take the time to read this Notice carefully and keep it with the copy of the Summary Plan Description ("Summary") that was previously provided to you. If you need another copy of the Summary or if you have any questions regarding this change to the Plan, please contact the Fund Office during normal business hours at 165 West 46th Street, 14th Floor New York, NY 10036-2582, telephone number (212) 869-9380.


On April 29, 1999, the Board of Trustees adopted the following improvements which shall apply to Health Plan participants not covered by an HMO effective June 1, 1999:

the deductible for Major Medical is reduced to $250.00 from $300.00
retroactive to January 1, 1999;

the Mental Health Reimbursement Maximum is increased to $50.00 from $10.00;

for certain surgical procedures, second surgical opinions before non-emergency procedures will no longer be mandatory. Second surgical opinions will still be available on a voluntary basis and will be fully paid for by the Fund; and

the mandatory seven-day waiting period between acupuncture treatments was eliminated.


On May 1, 2000, the Board of Trustees adopted the following changes to the Salary
Continuance Benefit of the Health Fund, effective as of July 1, 2000:

The Board of Trustees voted to self-insure and self-administer the Salary Continuance Benefit of the Health Fund.

In addition, the Trustees voted to formally change the name of this benefit from "Salary Continuance Benefit" to "Supplemental Workers’ Compensation Benefit."
Finally, the Trustees voted to improve benefits by adopting several benefit increases to the Supplemental Workers’ Compensation Benefit as follows:

(i) for all classes under the Supplemental Workers’ Compensation Benefit, the cap on benefits will be increased from $650 to 75% of the current Production Contract minimum salary, and

(ii) the cap shall be increased to 100% of the current Production Contract minimum salary for the high-risk classes only.



This Notice is intended to provide you with an easy-to-understand description of certain changes to the Plan. While every effort has been made to make this description as complete and as accurate as possible, this Notice, of course, cannot contain a full restatement of the terms and provisions of the Plan. If any conflict should arise between this Notice and the Plan, or if any point is not discussed in this Notice or is only partially discussed, the terms of the Plan will govern in all cases.

The Board of Trustees or its duly authorized designee, reserves the right, in its sole and absolute discretion, to amend, modify or terminate the Plan, or any benefits provided under the Plan, in whole or in part, at any time and for any reason, in accordance with the applicable amendment procedures established under the Plan and the Agreement and Declaration of Trust establishing the Plan (the "Trust Agreement"). The Trust Agreement is available at the Fund Office and may be inspected by you free of charge during normal business hours.

No individual other than the Board of Trustees (or its duly authorized designee) has any authority to interpret the plan documents, make any promises to you about benefits under the Plan, or to change any provision of the Plan. Only the Board of Trustees (or its duly authorized designee) has the exclusive right and power, in its sole and absolute discretion, to interpret the terms of the Plan and decide all matters arising under the Plan.


©2001, 2002 Equity League Pension and Health Funds This site does not change or otherwise interpret the official Plan documents. To the extent that any of the information contained in this website is inconsistent with the official Plan documents (which, of course, includes the Trustees' rights to amend or modify the Plans at any time), the plan documents will govern in all cases. No official (other than the Trustees) has any authority to interpret the Plans, or other official Plan documents, or to make any promises to you about them. Terms of Use | Privacy Policy