Plan Notices

When Plan changes are made, you receive a Plan Notice or written update (officially known as a Summary of Material Modifications or SMM). You can read the SMMs online—or download and print them. Contact the TBT Plan Administration Office if you are not sure which notices apply to you.

2022

To All TBT Participants, Covered Dependents and COBRA Participants in Active Plans I, I-A, I-85, III, III-A, IV, V, V-A and VI (except HMO participants)

Plan Changes regarding the No Surprises Act
(Your Rights and Protections against Surprise Medical Bills)
Notice dated September 2022 addressed to all TBT Participants, Covered Dependents and COBRA Participants effective October 2022

SMM – No Surprises Act (PDF)

2021

To All TBT Participants, Covered Dependents and COBRA Participants in Active Plans I, I-A, I-85, III, III-A, IV, V, V-A and VI and Non-Medicare Retirees under CRP, RSP Gold, RSP Silver and SRP (except Kaiser participants)

Plan Changes regarding New Drug Benefit Providers
Notice dated November 2021 effective January 2022

SMM – Change of Trust Pharmacy Benefits Manager (PDF)

2020

To All TBT Participants, Covered Dependents and COBRA Participants

COBRA Extension – Waiver of Premiums Due to COVID-19 for up to FOUR Months
Notice dated August 2020 addressed to all TBT Participants, Covered Dependents and COBRA Participants regarding “Zero Premium” COBRA extension from three months to fourth and final month.

SMM – COVID-19 Extension of 4th Month (PDF)

To All Teamsters Benefit Trust Active and Retired Participants, Covered Dependents and COBRA Participants

COVID-19 (“Coronavirus”) and Plan Deadlines – National Emergency Effective Immediately – July 2020
Notice dated August 20, 2020 addressed to all TBT Active and Retired Participants, Covered Dependents and COBRA Participants regarding (1) COBRA Extension, (2) Telemedicine, (3) Change of HMO Network, (4) Coverage of Preventive Care & Wellness, Autism, and Dental Cone Beam X-Rays.

COVID-19 Pandemic Period Claim Deadlines (PDF)

To All TBT Participants, Covered Dependents and COBRA Participants (except Kaiser participants)

Plan Changes regarding (1) COBRA Extension, (2) Telemedicine, (3) Change of HMO Network and (4) Coverage of Preventive Care & Wellness, Autism and Dental Cone Beam X-Rays
Notice dated July 2020 effective October 2020

SMM – TeleMedicine Autism ABX HMO Cone X-Rays Others (PDF)

To All Teamsters Benefit Trust International Plan Active and Retired Participants, Covered Dependents and COBRA Participants

COBRA Extension – Waiver of Premiums Due to COVID-19 for up to THREE Months
Notice dated July 8, 2020 addressed to all TBT International Plan Active and Retired Participants, Covered Dependents and COBRA Participants regarding (1) COBRA Extension, (2) Telemedicine, (3) Coverage of Preventive Care & Wellness, Autism, and Dental Cone Beam X-Rays.

SMM – INTERNATIONAL PLAN TeleMedicine Autism ABX HMO Cone X-Rays Other (PDF)

To All TBT Participants, Covered Dependents and COBRA Participants

Temporary Changes to Address COVID-19—Effective Immediately
First Notice addressed to all Participants, Dependents and COBRA Participants dated March 13, 2020:

1st Mailing – Temp Changes Covid-19 – All Participants (PDF)

To All TBT Participants, Covered Dependents and COBRA Participants

Coverage of Testing for COVID-19 (Coronavirus) and “telemedicine”—Effective Immediately Second Notice addressed to all Participants, Dependents and COBRA Participants dated March 25, 2020:

2nd Mailing – Your TBT Health Plan & Coronavirus-SMM – All Participants 03-25-20 (PDF)

To All TBT Participants, Covered Dependents and COBRA Participants

Continuing Your TBT Coverage if You are Laid Off: COBRA Self-Pay—Effective Immediately Third Notice addressed to all Participants, Dependents and COBRA Participants dated April 20, 2020:

3rd Mailing – COBRA Self-Pay – All Participants 04-20-20 (PDF)

To All Active and Retiree Plan Participants, Dependents and COBRA Participants in the TBT International Plan

Temporary Changes to Address COVID-19—Effective Immediately
First Notice addressed to all Participants, Dependents and COBRA Participants dated March 13, 2020:

1st Mailing – Temp Changes Covid-19 – International Plan 03-13-20 (PDF)

To All Active and Retiree Plan Participants, Dependents and COBRA Participants in the TBT International Plan

Coverage of Testing for COVID-19 (Coronavirus) and “telemedicine”—Effective Immediately Second Notice addressed to all Active and Retiree Plan Participants, Surviving Spouses, Eligible Dependents and COBRA Participants in the TBT International Plan dated March 25, 2020:

2nd Mailing – Your TBT Health Plan & Coronavirus-SMM – International Plan 03-30-20 (PDF)

To All Active and Retiree Plan Participants, Dependents and COBRA Participants in the TBT International Plan

Continuing Your TBT Coverage if You are Laid Off: COBRA Self-Pay—Effective Immediately Third Notice addressed to all Active and Retiree Plan Participants, Surviving Spouses, Eligible Dependents and COBRA Participants in the TBT International Plan dated April 20, 2020:

3rd Mailing – COBRA Self-Pay – International Plan 04-20-20 (PDF)

2018

TBT Non-Medicare Participants enrolled in the UnitedHealthcare HMO

Change From Managed Health Network (MHN) to Optum Health through UnitedHealthcare
For Mental Health Services Incurred as of January 1, 2019
Notice addressed to UnitedHealthcare Participants not enrolled in Medicare:

2018 – TBT SMM MHN to Optum Health 1-1-2019 (PDF)

United Healthcare Behavioral Health and Substance Abuse – MHSU Summary (PDF)

2016

All TBT Active and Retiree Plans

Post-Mastectomy Reconstructive Surgery Benefits
Annual notice addressed to Active and Retiree Participants and Dependents dated September 14, 2016:

2016 – Post-Mastectomy Benefits – Annual Notice – All TBT Active and Retiree Plans (PDF)

All Plans including CRP with Subsidy (No Wrap-Around)

Medicare Part D (Prescription Drugs) Notice of Creditable Coverage
Annual notice addressed to Medicare-Eligible Participants, Spouses and Dependents in all TBT Plans including Comprehensive Retiree Plan (CRP) With an Employer or Union Subsidy dated September 15, 2016:

2016 – All Plans including CRP with Subsidy (No Wrap-Around) (PDF)

CRP without Subsidy Wrap-Around PDP

Medicare Part D (Prescription Drugs) Notice of Creditable Coverage
Annual notice addressed to Comprehensive Retiree Plan (CRP) Medicare-Eligible Participants and Spouses Without an Employer or Union Subsidy dated September 15, 2016:

2016 – CRP without Subsidy Wrap-Around PDP (PDF)

Active Participants, Dependents and COBRA Enrollees in Plans I, I-A, I-85, III, III-A, IV, V, V-A, VI, and RSP Retirees

Plan Change Notice: (1) Change to Your Prescription Drug Benefits Coverage (“New To Market” Program) and (2) Disenrollment from Vision and Dental Coverage
Notice addressed to all Active Participants, Dependents and COBRA Enrollees in Plans I, I-A, I-85, III, III-A, IV, V, V-A, VI, and RSP Retirees dated July 15, 2016:

2016 – SMM Rx New To Market Program and Disenrollment (Vision Dental) (PDF)

2015

TBT Plans I, I-A, I-85, III, III-A, IV, V, V-A Construction and V-A-NEWS Active Participants, Dependents and COBRA Enrollees

Mental Health Parity and Addiction Equity Act (MHPAEA) Compliance and Annual Maximum Removed – Indemnity Plan Claims incurred on or after October 1, 2014
Notice addressed to Active Participant, Dependents and COBRA Enrollees in TBT Plans listed above (Non-Grandfathered) dated March 2, 2015:

2015 – Mental Health Parity and Substance Abuse Treatment – Plans I through V-A 10-01-14 (PDF)

TBT Plan V-A (Non-Grandfathered) Active Participants, Dependents and COBRA Enrollees

Mental Health Parity and Addiction Equity Act (MHPAEA) Compliance and Annual Maximum Removed – Indemnity Plan Claims incurred on or after October 1, 2014
Notice addressed to Active Participants, Dependents and COBRA Enrollees in TBT Plan V-A (Non-Grandfathered) dated March 3, 2015:

2015 – Mental Health Parity and Substance Abuse Treatment – Plan V-A Non-Grandfathered 10-01-14 (PDF)

TBT Plan VI (Non-Grandfathered) Active Participants, Dependents and COBRA Enrollees

Mental Health Parity and Addiction Equity Act (MHPAEA) Compliance and Annual Maximum Removed – Indemnity Plan Claims incurred on or after October 1, 2014
Notice addressed to Active Participants, Dependents and COBRA Enrollees in TBT Plan VI (Non-Grandfathered) dated March 3, 2015:

2015 – Mental Health Parity and Substance Abuse Treatment – Plan VI Non-Grandfathered 10-01-14 (PDF)

All Participants, Dependents and COBRA Enrollees in Plans I, I-A, I-85, III, III-A, IV, V, V-A, CRP, RSP and SRP

Plan Change Notice: OptumRx Specialty Pharmaceuticals Program Effective October 1, 2015
Notice addressed to all Participants, Dependents and COBRA Enrollees in Plans I, I-A, I-85, III, III-A, IV, V, V-A, CRP, RSP and SRP dated October 15, 2015:

2015 – OptumRx Specialty Pharmaceuticals Program (PDF)

All Active Participants, Dependents and COBRA Enrollees in Non-Grandfathered Plans V-A and VI

Plan Change Notice: OptumRx Specialty Pharmaceuticals Program Effective October 1, 2015
Notice addressed to all Active Participants, Dependents and COBRA Enrollees in Non-Grandfathered Plans V-A and VI dated October 15, 2015:

2015 – OptumRx Specialty Pharma Non-GFD – Plans V-A and VI (PDF)

2013

TBT Plans V and V-A Health and Welfare Coverage
Vision Care Benefits for Claims Incurred on or after January 1, 2013

Notice addressed to Active Participants in Plans V and V-A (including Plan V-A Construction) dated November 26, 2012:

2013 – SMM Vision Service Plan (VSP) for Plans V and V-A – GF Plan – Effective 1-1-13 (PDF)

2012

Medicare Part D (Prescription Drugs) Notice of Creditable Coverage

Annual notice addressed to Medicare-Eligible Participants, Spouses and Dependents in all TBT Plans including Comprehensive Retiree Plan (CRP) With an Employer or Union Subsidy dated August 31, 2012:

2012 – All Plans Including CRP With Subsidy (No Wrap-Around PDF)

Medicare Part D (Prescription Drugs) Notice of Creditable Coverage

Annual notice addressed to Comprehensive Retiree Plan (CRP) Medicare-Eligible Participants and Spouses Without an Employer or Union Subsidy dated August 31, 2012:

2012 – All Plans Including CRP Without Subsidy (Wrap-Around PDF)

Post-Mastectomy Reconstructive Surgery Benefits

Annual notice addressed to Active and Retiree Participants and Dependents dated August 31, 2012:

Post-Mastectomy Benefits – Annual Notice (A 3) TBT Plans) (PDF)

Plan I-85 – Retiree Self-Pay Subsidy Change for Eligible Retirees Age 60 and Over – Effective July 1, 2012

Notice addressed to Local 85 Comprehensive Retiree Plan (CRP) Retirees and Covered Spouses:

I-85 Subsidy Change Notice (Age 60 and Over) (PDF)

Plan VI – Summary of Changes to Medical Benefits for Plan VI – Effective February 1, 2012

Notice addressed to Plan VI Active and COBRA Participants and Their Dependents dated March 13, 2012 and Preventive Services attachment:

SMM Plan VI Non-Grandfathered (2-12) (PDF)

Preventive Services Under PPACT (Plan VI) (PDF)

2011

Supplemental Dental Plan – Allowances Revised Effective 12-1-11

Notice addressed to Supplemental Dental Plan Participants dated January 16, 2012

SMM – Supplemental Dental Plan (Allowances Revised Effective 12-1-11) (PDF)

Plan V-A – Reduction of Calendar Year Deductible – Effective January 1, 2011

Notice addressed to Plan V-A Active Participants dated December 29, 2010:

Plan V-A Amendment to Indemnity Medical Calendar Year Deductibles (effective 1-1-11) (PDF)

2010

Annual Maximums Found in Plans I, I-85, I-A, III, III-A, IV, V, V-A and VI – Effective October 1, 2010

Notice addressed to all active participants and dependents dated October 15, 2010

SMM – PPACA Annual Maximums (all TBT Active Plans)_10-10 (PDF)

Eligibility of Children Under Age 26 and Lifetime Maximum – Effective October 1, 2010

Notice addressed to Active and Retiree Participants and Dependents dated August 25, 2010

SMM – PPACA Notice (1) Eligibility of Children & (2) Lifetime Maximum 8-10 (PDF)

Name Change for Retirement Security Plan: RSP Gold, Introduction of RSP Silver, RSP 2010 Rate Increase and RSP Post-Retirement Self-Payments – Effective July 1, 2010

Notice addressed to Active and Retired Participants in the Retirement Security Plan dated April 29, 2010

(English) SMM – RSP Name Change RSP Silver and Post-Retirement Self-Pay Policy (Non-TBT) (PDF)

(Spanish) SMM – RSP Name Change RSP Silver and Post-Retirement Self-Pay Policy (Non-TBT) (PDF)

Changes for Indemnity Medical Option: Mammograms, Pediatric Vaccinations, Claims’ Statute of Limitations and Coordination of Benefits Rules – Effective January 1, 2010

Notice addressed to Active and Retired Participants in the Indemnity Medical Option dated December 30, 2009

SMM – Mammograms Vaccines Statute of Limitations and COB Policy (PDF)

2009

TBT PacifiCare HMO Option – Change from Optum Health to Managed Health Network (MHN) for Mental Health Services – Effective October 1, 2009

Notice addressed to Active (Non-Medicare) Participants in the United HealthCare (formerly PacifiCare) HMO option dated September 18, 2009

SMM – Change from Optum Health to HMN on 10-1-09 (PDF)

Retirement Security Plan (RSP) Retiree Domestic Partner Taxes Effective July 1, 2009

Notice addressed to Active and Retired Participants in the Retirement Security Plan dated July 22, 2009

(English) SMM – RSP Domestic Partners Tax Obligation Effective 7-1-09 (PDF)

(Spanish) SMM – RSP Domestic Partners Tax Obligation Effective 7-1-09 (PDF)

2008

Changes for Indemnity Medical Option: Increased Lifetime Maximum Effective October 1, 2008

Notice addressed to Active and Retired Participants in the Indemnity Medical Option dated August 1, 2008

SMM – Lifetime Maximum 10-1-08 (PDF)

Delta Dental Enhanced Standard Benefits – Effective January 1, 2008

Notice addressed to Active and Retired Participants dated November 30, 2007

SMM – Delta Dental Enhanced Benefits – 01-01-08 (PDF)

2007

Preventive Care Benefit Increase – Effective October 1, 2007

Notice addressed to Active and Retired Participants dated October 1, 2007

SMM – Preventive Care Change Effect 10-1-07 (PDF)

New Employee Delta Dental Waiting Period Procedural Change – Effective August 1, 2007

Notice addressed to Active Participants dated August 1, 2007

(English) Delta Dental Waiting Period 8-1-07 (PDF)

(Spanish) Delta Dental Waiting Period 8-1-07 (PDF)

Open Enrollment Procedural Change – Effective August 1, 2007

Notice addressed to all active and retired participants dated August 1, 2007

(English) Open Enrollment Procedure Change 8-1-07 (PDF)

(Spanish) Open Enrollment Procedure Change 8-1-07 (PDF)

Direct Debit Services Available for Retiree Monthly Self-Payments and Prescription Solutions Mandatory Mail Service Program for Maintenance Medications – Effective Since April 1, 2004

Notice addressed to Participants in the Comprehensive Retiree Plan (CRP), Retirement Security Plan (RSP) and Supplemental Retiree Plan (SRP) dated January 10, 2007

Retirees Notice ACH Debit Account 1-10-07 (PDF)

2006

Injectable Drugs – Prescription Solutions Specialty Pharmacy Program – Effective July 1, 2006

Notice addressed to Active and Retired Participants dated July 1, 2006

Specialty Pharmacy Program – Injectable Drugs 7-1-06 (PDF)

2005

TBT PacifiCare HMO Option – Injectable Medications Benefit Change – Effective May 23, 2005

Notice addressed to Active and Retired Participants in the PacifiCare HMO Option dated May 23, 2005

SMM – PacifiCare – Injectable Drugs 5-23-05 (PDF)