Tuesday, May 11, 2021

Frequently Asked Claims Questions


Q.

Who is the Prescription Drug Benefit Manager?

A.

Express Scripts.

Q.

How can I contact the Prescription Drug Benefit Manager?

A.

www.expressscripts.com or (855) 202-9582

Q.

If a service I need requires Prior Authorization, who do I (or my provider) contact?

A.

CIGNA at (866) 249-3808 for CT Scans, MRI & PET Scans and CIGNA at (800) 768-4695 for all other inquiries.

Q.

If I need to utilize Mental Health or Substance Abuse benefits, who do I contact?

A.

To find a contracted Mental Health or Substance Abuse provider utilize the CIGNA website at www.cignasharedadministration.com or contact CIGNA directly at (800) 768-4695.

Q.

How do I find a dentist or find out if my dentist participates with Careington Dental?

A.

Visit www.metlife.com/mybenefits or call (800) 942-0854.

Q.

If I have Medicare, who does my provider submit the claim to?

A.

For claims 12/31/19 and prior, providers should submit claims to IBEW District 8 at PO Box 2068, Farmingto, MI 48333.  For services 1/1/2020 and current providers should sumbit to UnitedHealthcare at PO Box 31362, Salt Lake City, UT 84131-0362. 

Q.

Who are my Vision benefits through and how can I contact them?

A.

Vision benefits are reimbursed through the Trust Fund Office.  You may email websupport@benesys.com or call (844) 989-2321 or (314) 656-1085 to speak to a Member Service Representative.

Q.

Eligibility, How do I become eligible for Disability Benefits.

A.

Active employees are eligible when required contributions are negotiated and paid.

Q.

Does the fund offer any extensions?

A.

No.

Q.

How much does the Disability Benefit Pay per week?

A.

Occupational Disability $30.00/week / Non-Occupational Disability $250.00/week

Q.

How long can I collect a Disability Benefit?

A.

Thirty-nine (39) weeks for any one (1) disability. Successive periods of disability separated by less than thirty (30) days of full-time work will considered one (1) period of disability, except if due to an unrelated cause or Illness.

Q.

Are there any Death Benefits Available? How do I qualify for Death Benefits?

A.

Yes, You must be eligible in Health & Welfare at the time of Death

Q.

Is there a filing limit for Death Benefits.

A.

Yes, applications must be submitted within 90 days after date of loss. Eligibility will end the earlier of 1. If a Retiree, Disabled or COBRA members first day of calendar month in which they reach age 65; 2. Last day of the calendar month in which employment terminates (unless you are a Retiree, Disabled for a COBRA beneficiary), and you elect to Self Pay the required amount to be eligible; 3. The date an Active member or former employee is no longer eligible for benefits from the Fund.

Q.

Who is Eligible for the Death Benefit?

A.

Active: Depending on Plan

Active Spouse: Depending on Regular or Basic Plan

Regular Retiree: Depending on Regular or Basic Plan

Surviving Spouse: Depending on Regular or Basic Plan

*Contact Benefit Office to see what coverage you carry. Regular or Basic Plan. *

Q.

How Much Does the Benefit Pay?

A.

Contact the Benefit Office, benefit amounts are based of your current Plan.

Q.

How are benefits paid out, who receives the benefits when I pass?

A.

Death Benefits are paid to the person whom you listed on your Beneficiary Designation Card/Vital Form. Beneficiaries can be changed at anytime . We strongly suggest you update your beneficiary once a year or after any life changing event i.e.. Marriage or Divorce.

Q.

How is the money deposited into my account?

A.

Employer Contributions Only. You cannot add money into your account.

Q.

Is there a minimum reimbursement amount?

A.

Yes, Manual Claims $25.00 / Benny Card $50.00

Q.

Can I use the PCA reimbursement account for Self payments? What about COBRA?

A.

Yes.

Q.

Is the a filing limit?

A.

Yes, claims must be filed by July 1st of the year following the year in which the claims were incurred. 

Q.

Can I lose my balance?

A.

Yes, Inactive accounts (no money coming in or going out) will be charged $25.00 each year. After three (3) years of continuous inactivity, all remaining funds will be automatically and permanently forfeited.