Thursday, September 28, 2023

Frequently Asked Health Care Questions

Q. When do I become eligible for benefits?
A. This depends on your coverage election:

Requirement for Member + Dependent Coverage (Family) NO DENTAL = 126 hours per month
Requirement for Member + Dependent Coverage (Family) WITH DENTAL = 130 hours per month

Requirement Single Coverage NO DENTAL = 82 hours per month
Requirement Single Coverage WITH DENTAL = 84 hours per month

Work Months = Insurance Eligibility Months
January = April
February = May
March = June
April = July
May = August
June = September
July = October
August = November
September = December
October = January
November = February
December = March
Q. What is the Supplemental Health Reimbursement Account (SHRA)?
A. This is an account used for your future insurance eligibility deductions and may also be used for reimbursements of your out-of-pocket medical expenses. See your Supplemental Health Reimbursement Plan Description for details. Members who have a minimum of six months Health & Welfare coverage “banked” have a SHRA which represents the Health & Welfare contributions in excess of the six month coverage requirement. You can download the filing instructions and a claim form off of this website located under “Forms”.
Q. What healthcare plans are available?
A.Medical Mutual (PPO) – Medical and Dental
Sav-Rx - Prescription
Q. Who are my eligible dependents?
  • Your lawful spouse
  • Natural child through age 25
  • Step-child through age 25
  • Legal ward of employee through age 25
  • Adopted child or child placed with member for purpose of adoption
  • Unmarried children, over age 25, who are totally disabled. If totally disabled and primarily dependent on the member for support, eligibility will continue past the age limit provided the disability started before age 26 and is medically certified by a Physician. Continued proof of disability will be required.
Q. Whom do I call if I have questions about my eligibility?
A. The Fund’s Office at: 216- 520-1644
Q. Are there any disability benefits available from the Plan?
A. Yes, a weekly disability benefit, maximum of 13 weeks may be available to you. $125/week for non-occupational illness or injury and $75/week for occupational injury. Please contact the Fund’s Office at 216-520-1644 for additional information.
Q. What documents are required to add a new dependent to my Plan?
  • Spouse – copy of your marriage certificate
  • Child – copy of your child’s original birth certificate (If you are enrolling a newborn, a hospital certificate will be good for 90 days from date of birth and then a copy of the original birth certificate must be submitted.)
  • Step-Child – copy of original birth certificate & proof that you the member support this child. Acceptable documents may include proof of residency from child’s school, Tax return claiming child, divorce documents stating that parent has primary custody of Child and is required to provide healthcare coverage.
  • Adopted Child – copy of legal adoption documents from the court or letter from the state Adoption agency stating the date the child was placed in the home for purpose of legal Adoption. Upon completion of legal adoption, the Fund’s Office will need a copy of the final legal adoptions documents.
  • Legal Ward – copy of Court’s Letter of Guardianship