Glossary of Commonly Used Terms
The “employee” is performing all of the regular duties of his or her employment.
COBRA (Consolidated OmniBus Reconciliation Act)
A federal law that extends health and welfare benefits.
Collective Bargaining Agreement
A labor agreement between an Employer and a Local Union providing for contributions to the plan, which has been approved by the Labor Alliance Managed Trust Fund Board of Trustees.
An amount which the participant is obligated to pay to the provider for certain services and benefits.
During Any Disability
- FOR YOU: All periods of disability arising from the same cause; except that if you completely recover or return to active employment, any subsequent period of disability from the same cause will be considered a new disability.
- FOR YOUR DEPENDENT: All periods of disability arising from the same cause; except in case of recovery for a period of six (6) months during which he or she is capable of resuming the normal activities of a person in good health and of the same age and gender, any subsequent period of disability from the same cause will be considered a new disability.
The common law employees of a participating employer.
HMO stands for Health Maintenance Organization. An HMO is an organization of healthcare providers, including hospitals and diagnostic centers. An HMO provides all medical services on a prepaid basis. A participant must choose a primary care physician who is a member of the HMO nework. HMOs provide coverage for in-network care only. In addition, co-payments are applicable for certain services and benefits. Each HMO has its own rules and requirements.
The Medical Care for Public Assistance Recipients program under the California Welfare and Institutions Code Sec. 14000 et. seq., as amended.
The Health Insurance for the Aged program under Title XVIII of the Social Security Act, as such Act was amended by the Social Security Amendments of 1965 (Public Law 89-97), as amended.
Any Employer or successor in interest to such Employer who is party to a “Collective Bargaining Agreement” requiring contributions to the Trust Fund.
PPO stands for Preferred Provider Organization (sometimes also referred to as a Participating Provider Organization). A PPO is a managed care organization of medical doctors, hospitals and other health care providers who have contracted with an insurer to provide health care at reduced rates to the insurer and participating members. PPO participants are free to either use physicians and hospitals within the PPO’s network or go outside of the network. However, there may be significantly higher out-of-pocket costs when utilizing an out-of-network provider.
You are unable, because of illness or injury, to carry on the regular and customary activities of a person in good health of the same age and gender and are not, in fact, engaged in any employment or occupation whatsoever for compensation, gain or profit. Disabilities resulting from purposefully self-inflicted injuries, participation in the commission of a felony and injuries or illness due to service in the Armed Forces and if the “employee” received a military pension are excluded.
The Labor Alliance Managed Trust Fund.