Wednesday, December 4, 2024

Frequently Asked Health Care Questions


Q.

Who is eligible to become a Participant in the Plan?

A.

An eligible employee is one who works under a Collective Bargaining Agreement that requires an Employer to make contributions on his or her behalf to the Fund. The employee will become eligible for “Active Employee Medical Coverage” on the first day of the second calendar quarter, following a period not to exceed four consecutive calendar quarters during which he or she worked at least 550 hours in no more than three out of the four calendar quarters in this period. Each eligible Participant must complete and submit to the Fund Office an Enrollment Form, which may be obtained from the Local Union Business Manager or the Fund Office.

Q.

What if I don’t work enough hours to gain eligibility for the month?

A.

You and your Dependent’s eligibility will terminate when you fail to work at least 550 hours in three (3) out of four (4) consecutive calendar quarters.

Q.

How do I maintain my monthly Health Care coverage?

A.

An employee must work 550 hours in 3 out 4 consecutive calendar quarters. If an Employee’s eligibility terminates, and he or she thereafter returns to work in Covered Employment, eligibility can be reinstated by satisfying the provisions for initial eligibility as shown above.

Q.

How do I make a payment towards the continuation of my Health Care coverage? 

A.

Members can make payments for COBRA by check or money order made payable to the Washington DC Cement Masons Welfare Fund and mailed to the Fund Office at 7130 Columbia Gateway Dr., Suite A, Columbia, MD 21046.

Q.

Whom should I call if I have questions about my Health Care eligibility?

A.

Members should contact the eligibility department at the Fund Office by calling (410) 872-9500.

Q.

Who are my eligible dependents?

A.

Eligible dependents are the participant's spouse, natural children, legally adopted children, children lawfully placed in the participants home in anticipation of adoption, participants legal stepchildren, and eligible foster children lawfully placed in the participants home by an authorized placement agency or by judgement, decree or other order of any court or administrative agency of competent jurisdiction.

Q.

Will my child(ren) who is/are age 19 through age 26 be covered under the Plan?

A.

Yes, dependent children are eligible through the end of the month in which they turn age 26

Q.

Whom should I contact if I'm getting a divorce and what documents do I need to submit?

A.

Members are obligated to promptly notify the Fund Office in writing following a divorce.

Q.

How do I obtain a replacement Medical and Prescription Card?

A.

Contact the Fund Office at (410) 872-9500 to request a replacement medical/prescription card.

Q.

How do I inquire about the status of my medical claim?

A.

Members should contact the claims department at the Fund Office at (410) 872-9500.

Q.

Who is the Prescription Drug Benefit Manager?

A.

CVS Caremark

Q.

How can I contact the Prescription Drug Benefit Manager?

A.

CVS Caremark at 866-282-8503.

Q.

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

A.

American Health Holdings at 800-641-5566.

Q.

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

A.

Please contact the Fund Office at 410-872-9500.

Q.

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

A.

Paper claim along with Medicare EOB must be submitted to Fund Office:

Washington, DC Cement Masons
7130 Columbia Gateway Dr. Ste A
Columbia MD, 21046

Q.

How do I become eligible for Disability Benefits?

A.

A weekly benefit is payable to an Employee while disabled and prevented from working as a result of a non-occupational accident or an Injury or Illness for which benefits are not payable under a Workers’ Compensation Law.

It is not necessary for an Employee to be confined to home to collect benefits but he or she must be under the care of a licensed Physician and may not engage in any other work for cash or other remuneration during the period of disability.

Once an Employee has begun to receive these benefits, he or she will be required from time to time to have a doctor complete a supplemental form indicating whether or not the Employee is still disabled. This form will be sent to the Employee from the Fund Office and must be returned to the Fund Office within two weeks of receipt.

Q.

Does the fund offer any extensions?

A.

There are no extensions allowed.

Q.

How much does the Disability Benefit Pay per week?

A.

Tier One: $200 per week

Tier Two: $150 per week for disabilities occurring 4/1/2018 & after

Q.

How long can I collect a Disability Benefit?

A.

26 Weeks per disability.

Q.

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

A.

Yes, Member must be an active member at time of death.

Q.

Is there a filing limit for Death Benefits?

A.

12 months

Q.

Who is Eligible for the Death Benefit?

A.

Active & Retired Employees

Q.

How Much Does the Benefit Pay?

A.

Active - $10,000
Retired on or after 1/1/2001 - $5,000
Retired between 1/1/1984 and 12/31/2000 - $2,000
Retired between 1/1/1975 and 12/31/1983 - $1,500
Retired prior to 1/1/1975 - $500

Q.

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

A.

Benefits are paid out in a form of a paper check to the named beneficiary at the time of death.