TWR & NJ Health Care Fund - Regarding Retiree Health Benefits

**IMPORTANT NOTICE 2024**

Regarding Retiree Health Benefits

Did you know that you may forfeit your rights to Retiree Health Benefits with this

Trust Fund if you do not submit a written application or deferral within 60 days of

your retirement?

AS YOU PREPARE FOR YOUR RETIREMENT…

Please contact the Administrative Office at (855) 215-2039 or

see the reverse side of this notice for important steps to follow when you are ready to retire.

The Retiree Health Plan includes:

❖ Medical Benefits ❖ Prescription Drugs

❖ Dental Benefits ❖ Vision Benefits

Please note:

Enrollment is not Automatic!

If you do not apply in a timely manner, you will forfeit participation.

To be eligible you:

✓ MUST APPLY WITHIN 60 DAYS of your Retirement Effective Date or your

Notice of Award (whichever is earlier) and you

✓ MUST Enroll in Medicare Part A and Part B. This applies to individuals

aged 65 or older as well to those eligible for Medicare due to a disability, and you

✓ MUST also meet certain Eligibility Rules

Teamsters Western Region & New Jersey Health Care Fund

Retiree Health benefits

Starting January 1, 2025, if you are eligible for Medicare, this Retiree Health Care Plan will not

be available until you are enrolled in Medicare Parts A and B.

Important: There cannot be a lapse in coverage between the Active and Retiree Health Plans unless

you’ve requested a One-Time Deferral. Your written Deferral request must include proof of other health

coverage and the effective date of such coverage. When you are ready to participate (or re-participate),

you must provide proof of other health coverage for the entire deferral period.

Please note that COBRA continuation of benefits can be used to prevent a lapse in coverage but cannot

be used to meet service requirements. This is important if your active plan benefits end due to an

extended Disability.

A) Verify that your dependents will continue to be eligible:

a. Newly acquired Spouses cannot be added after your initial enrollment or deferral.

b. Coverage for Dependent children terminates at age 19 or up to age 25, if they are a Full

Time Student attending college or an accredited school. Full-Time Student Status must

be verified each semester to continue coverage.

B) Go to www.wr177healthcare.com to review the Summary Plan Description for the Retiree

Health Plan to familiarize you and your covered dependents with the Retiree Health Plan benefit

schedule.

C) If you or your dependent(s) are eligible for Medicare when you apply for the Retiree Health Plan

You MUST BE ENROLLED in MEDICARE PART A and PART B, even if you or your

dependents are eligible for Medicare Eligible due to a disability.

If Medicare-eligible, you MUST ENROLL in MEDICARE PART A and PART B, when you are

first offered that opportunity and especially once you retire. If not enrolled in Medicare Part A

and Part B when first eligible, a Lifetime Part B Late Enrollment Penalty may be applied by

Medicare.

Once enrolled in the Retiree Health Plan and you later become eligible for Medicare, you must

provide proof of Medicare Enrollment in both Medicare Part A and Part B. If not provided,

coverage will be suspended starting the first month after you become Medicare-Eligible.

D) Go to www.wr177healthcare.com to review the Retiree Self-Pay Rates for the cost of coverage

for you and your eligible dependents.

Note: Monthly Self-Pay rates must be received no later than the 15th day of the month prior to

the coverage month and the plan will accept (EFT/Direct Payment) from your bank account.

For additional Retiree Health Plan information

Please contact the Administrative Office at (855) 215-2039.

Administrator: Southwest Service Administrators, Inc.

P.O. Box 43110, Phoenix, AZ 85080-3110 ● Phone: 855-215-2039 ● Fax: 602-324-0555● www.wr177healthcare.com