Plan Booklet : Puget Sound Electrical Workers Trusts

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Plan 1

A guide to your Health Plan Benefits: Summary Plan Description (Healthcare Plan Booklet).

Changes to your plan since the last printed Summary Plan Description:

Amendment Date	Amendment	Participation
Amendment Date	06/30/2025	Amendment	Plan Benefit Change – Modifications to ABA Therapy Services, Habilitative Benefits, Rehabilitative Therapy, and Medical Plan Exclusions	Participation	All Active Participants
Amendment Date	06/13/2025	Amendment	New Benefit - Virta Diabetes & Weight Loss Management	Participation	All Active and Non-Medicare Participants
Amendment Date	04/01/2025	Amendment	Dollar Bank Changes Plan 1 – Effective May 2025 Eligibility	Participation	Port of Seattle - Plan 1 Participants
Amendment Date	02/28/2025	Amendment	Dollar Bank Changes Plan 1 – Effective April 2025 Eligibility	Participation	All Plan 1 Participants
Amendment Date	11/27/2024	Amendment	Telemedicine and Dollar Bank Deduction Changes - Effective January 2025 Eligibility	Participation	All Plan 1 Participants
Amendment Date	5/1/2024	Amendment	Pediatric Chiropractic Care	Participation	All Eligible Plan Participants
Amendment Date	1/31/2024	Amendment	Plan Benefit Changes	Participation	All Eligible Plan and Medicare Retiree Participants
Amendment Date	1/31/2024	Amendment	Dollar Bank Changes - Plan 1	Participation	All Plan 1 Participants
Amendment Date	7/7/2023	Amendment	Plan Benefit Changes	Participation	All Eligible Plan Participants
Amendment Date	10/12/2022	Amendment	Benefit Changes - Hearing Aids, Transgender Health Services, Dental PPE and Telehealth	Participation	All Eligible Plan Participants
Amendment Date	7/1/2022	Amendment	No Surprises Act Notice	Participation	All Eligible Plan Participants
Amendment Date	5/2/2022	Amendment	COVID-19 OTC Benefits and Telemedicine Temporary Extension	Participation	All Plan Participants
Amendment Date	5/2/2022	Amendment	Dollar Bank Changes	Participation	All Plan 1 Participants
Amendment Date	9/1/2021	Amendment	Maternity Leave Benefit	Participation	All Eligible Plan Participants
Amendment Date	5/14/2021	Amendment	Correction to SPD & COVID-19 Extensions	Participation	All Eligible Plan Participants
Amendment Date	2/2/2021	Amendment	Benefit Changes	Participation	All Eligible Plan Participants
Amendment Date	10/9/2020	Amendment	Extension of Plan Deadlines and Benefit Changes (Gene and Cellular Therapy)	Participation	All Active and Non-Medicare Participants
Amendment Date	7/1/2020	Amendment	Benefit Changes and Extension of Plan Deadlines	Participation	All Plan Participants
Amendment Date	5/21/2020	Amendment	Extension of Benefits due to Coronavirus Emergency and Dental Exclusion Changes	Participation	All Plan Participants
Amendment Date	03/20/2020	Amendment	Response to Coronavirus Outbreak	Participation	All Eligible Plan Participants
Amendment Date	2/28/2020	Amendment	Life Insurance and Dollar Bank Changes Eff. 4/1/2020	Participation	All Active Participants
Amendment Date	12/03/2019	Amendment	Correction to the SPD - Orthodontia Coverage	Participation	All Plan Participants
Amendment Date	10/14/2019	Amendment	Life and AD&D Benefits Eff. 9/1/2019	Participation	All Plan Participants
Amendment Date	7/1/2019	Amendment	Dollar Bank Increase & Telemedicine Services	Participation	All Active and Non-Medicare Participants
Amendment Date	6/11/2019	Amendment	Retiree Delayed Enrollment	Participation	All Plan Participants
Amendment Date	5/30/2019	Amendment	Adult Dependent Opt-Out	Participation	All Active Participants
Amendment Date	1/23/2019	Amendment	New SPD and Benefit Changes	Participation	All Plan Participants
Amendment Date	12/27/2018	Amendment	Benefit Changes Eff. 1/1/2019	Participation	All Plan Participants

Plan 2

A guide to your Health Plan Benefits: Summary Plan Description (Health Plan Booklet).

Changes to your plan since the last printed Summary Plan Description:

Amendment Date	Amendment	Participation
Amendment Date	06/30/2025	Amendment	Plan Benefit Change – Modifications to ABA Therapy Services, Habilitative Benefits, Rehabilitative Therapy, and Medical Plan Exclusions	Participation	All Active Participants
Amendment Date	06/13/2025	Amendment	New Benefit - Virta Diabetes & Weight Loss Management	Participation	All Active and Non-Medicare Participants
Amendment Date	2/28/2025	Amendment	Dollar Bank Changes Plan 2 – Effective April 2025 Eligibility	Participation	All Plan 2 Participants
Amendment Date	11/27/2024	Amendment	Telemedicine and Dollar Bank Deduction Changes - Effective January 2025 Eligibility	Participation	All Plan 2 Participants
Amendment Date	5/1/2024	Amendment	Pediatric Chiropractic Care	Participation	All Eligible Plan Participants
Amendment Date	1/31/2024	Amendment	Plan Benefit Changes	Participation	All Eligible Plan and Medicare Retiree Participants
Amendment Date	1/31/2024	Amendment	Dollar Bank Changes - Plan 2	Participation	All Plan 2 Participants
Amendment Date	7/7/2023	Amendment	Plan Benefit Changes	Participation	All Eligible Plan Participants
Amendment Date	10/12/2022	Amendment	Benefit Changes - Hearing Aids, Transgender Health Services, Dental PPE and Telehealth	Participation	All Eligible Plan Participants
Amendment Date	5/2/2022	Amendment	COVID-19 OTC Benefits and Telemedicine Temporary Extension	Participation	All Plan Participants
Amendment Date	5/2/2022	Amendment	Dollar Bank Changes Plan Benefit Changes	Participation	All Plan 2 Participants
Amendment Date	9/1/2021	Amendment	Maternity Leave Benefit	Participation	All Eligible Plan Participants
Amendment Date	5/14/2021	Amendment	Correction to SPD & COVID-19 Extensions	Participation	All Eligible Plan Participants
Amendment Date	2/2/2021	Amendment	Benefit Changes	Participation	All Eligible Plan Participants
Amendment Date	10/9/2020	Amendment	Extension of Plan Deadlines and Benefit Changes (Gene and Cellular Therapy)	Participation	All Active and Non-Medicare Participants
Amendment Date	7/1/2020	Amendment	Benefit Changes and Extension of Plan Deadlines	Participation	All Plan Participants
Amendment Date	5/21/2020	Amendment	Extension of Benefits due to Coronavirus Emergency and Dental Exclusion Changes	Participation	All Plan Participants
Amendment Date	03/20/2020	Amendment	Response to Coronavirus Outbreak	Participation	All Eligible Plan Participants
Amendment Date	2/28/2020	Amendment	Life Insurance and Dollar Bank Changes Eff. 4/1/2020	Participation	All Active Participants

Retiree Plan

A guide to your Health Plan Benefits: Summary Plan Description (Health Plan Booklet).

Changes to your plan since the last printed Summary Plan Description:

Amendment Date	Amendment	Participation
Amendment Date	06/13/2025	Amendment	New Benefit - Virta Diabetes & Weight Loss Management	Participation	All Active and Non-Medicare Participants
Amendment Date	12/4/2024	Amendment	Telemedicine Changes	Participation	All Non-Medicare Retiree Participants and Eligible Dependents
Amendment Date	11/4/2024	Amendment	RetireeFirst Announcement Letter RetireeFirst FAQs	Participation	All Eligible Medicare-Eligible Retirees and Dependents
Amendment Date	10/23/2024	Amendment	Plan Benefit Changes	Participation	All Eligible Plan and Medicare Retiree Participants
Amendment Date	1/31/2024	Amendment	Plan Benefit Changes	Participation	All Eligible Plan and Medicare Retiree Participants
Amendment Date	7/7/2023	Amendment	Plan Benefit Changes	Participation	All Eligible Plan Participants
Amendment Date	10/12/2022	Amendment	Benefit Changes - Hearing Aids, Transgender Health Services, Dental PPE and Telehealth	Participation	All Eligible Plan Participants
Amendment Date	5/14/2021	Amendment	COVID-19 Extensions	Participation	All Eligible Plan Participants
Amendment Date	2/2/2021	Amendment	Benefit Changes	Participation	All Eligible Plan Participants
Amendment Date	10/9/2020	Amendment	Extension of Plan Deadlines and Benefit Changes (Gene and Cellular Therapy)	Participation	All Active and Non-Medicare Participants