D. YOUR RESPONSIBILITIES

1. Your Mailing Address.

Be sure to keep the Plan Office advised of changes in your address. Even if you leave the electrical industry or your Local Union you may continue to receive Plan information regarding your potential entitlement to benefits in the future.

2. Enrollment Form.

You should keep your enrollment form updated by adding new spouse, Domestic Partner or children with required proof, such as a marriage or Domestic Partner registration certificate, birth certificate and/or legal adoption papers). You are required to notify the Plan Office if a Dependent no longer meets the Plan’s requirements (e.g., divorce, death and over-age dependents).

3. Beneficiary Form.

You should complete a beneficiary form for the payment of the Plan’s death benefit (currently $1,000), and keep it current so that family members or others that you wish to receive your benefits receive them without delay. If you are married, benefits are automatically paid to your legal spouse unless he or she consents in writing before a notary. You should consider submitting a new form if there is a major change in your life circumstance (such as a marriage or divorce).

4. Privacy Protected Health Information.

The Board of Trustees has adopted certain privacy rules and forms in accordance with the Health Insurance Portability Accountability Act of 1996 (“HIPAA”). If you wish to authorize someone other than yourself to access information, you must complete the Authorization Form (which is available at the Plan Office) and return it to the Plan Office.