Thursday, February 5, 2026

Frequently Asked Health Care Questions


Q. Who is eligible to become a Participant in the Plan?
A. You are eligible to participate in the Plan if you work for an Employer that is required to make contributions to the Health and Welfare Plan for the work you perform. For most Participants, this means working in a position covered by a Collective Bargaining Agreement between the Employer and the Union.
Q. What if I don’t work enough hours to gain eligibility for the month?
A. If you fail to have the required employer contributions to continue Health Care coverage, you may be eligible to make payment as a self-pay Employee directly to the Plan, or you may be eligible to continue with COBRA Continuation Coverage.
Please contact the Trust Fund Office at (925) 398-7042 or Toll Free at (844) 685-6409.
Q. How do I maintain my monthly Health Care coverage?
A. You must have an employer contribution submitted on your behalf each month or elect COBRA Continuation Coverage and submit a self payment to continue Health Care coverage.
Q. How do I make a payment towards the continuation of my Health Care coverage?
A. You may make a self payment to remain eligible for the Health Care coverage through the Retiree or COBRA Continuation Coverage programs. You may mail your check or money order to:

Heat & Frost Insulators Local 16
P.O. Box 3625
Hayward
CA 94540-3625
Q. Whom should I call if I have questions about my Health Care eligibility?
A. Please contact the Trust Fund Office at (925) 398-7042 or Toll Free at (844) 685-6409.
Q. Who are my eligible dependents?
A.
  • Your lawful spouse
  • Your Registered Domestic Partner
  • Your natural children up to age 26
  • Your legally adopted children up to age 26
  • Your step-children up to age 26
Q. Will my child(ren) who is/are age 19 through age 26 be covered under the Plan?
A. Yes. Due to the new Healthcare Reform Act, dependent children are now eligible to remain covered until the age of 26, regardless of student status.
Q. How do I add my new baby or spouse to my insurance plan?
A. You must submit legal documentation to the Trust Fund Office, along with a completed Enrollment Form. You can download the Enrollment Form off of this website located under "Forms" and mail it into the Trust Fund Office. Forms Required Are:
  • Spouse - Copy of your marriage certificate.
  • Domestic Partner - Copy of the Plan's Affidavit of Domestic Partnership with a copy of the State of California Certificate of Domestic Partnership.
  • Child - Copy of your child's birth certificate.
  • Step-Child - Copy of child's original birth certificate along with proof of residency (Tax Returns & Divorce Decree/Court Documents)
Q. Whom should I contact if I'm getting a divorce and what documents do I need to submit?
A. Please call the Benefit Office and advise the Eligibility Department that you are getting a divorce or have already gotten divorced. You will also need to submit a FULL copy of your Dissolution of Marriage Judgment, QDRO (Qualified Domestic Relations Order) and Qualified Medical Child Support Order to this office.
Q. How do I obtain a replacement Medical Card?
A. Please send an email to staff@insulators16benefits.org , or contact the Trust Fund Office at (925) 398-7042
or Toll Free at (844) 685-6409.
Q. How do I inquire about the status of my medical claim?
A. First, you log-in to this website with your username and password. After log-in, please hover over "Member Benefits" and then click "Healthcare Claims" from the drop down menu.


Claims

Q. Who is the Prescription Drug Benefit Manager?
A. Envision Rx.
Q.How can I contact the Prescription Drug Benefit Manager?
A. Call (800) 361-4542 or visit www.envisionrx.com .
Q. If a service I need requires Prior Authorization, who do I (or my provider) contact?
A. Contact Blue Cross at  (800) 274-7767; or www.bluecrossca.com.
Q.If I need to utilize Mental Health or Substance Abuse benefits, who do I contact?
A. Contact Blue Cross at  (800) 274-7767; or www.bluecrossca.com.
Q.What if I do not see the status of a claim I am checking on?
A. One of the most common reasons for not being able to view a claim status is the provider has not submitted the claim. This may be due to a wrong address to where the provider is submitting the claim. Or it may simply have to be re-submitted. You may call your provider of service and inform them that they may need to re-submit a particular claim.
Q.How do I know the reason why a claim has not paid?
A. You are able to view the Explanation of Benefits (EOB) for each claim that has been received. On this EOB, under Reason Code, it will explain the cause of why an entire claim was denied, or why a single line item was denied. If you need further explanation, you may call the Trust Fund Office at (925) 398-7042 or Toll Free at (800) 685-6409. You can also email the Trust Fund Office at staff@insulators16benefits.org .
Q.How do I obtain a replacement Medical Card?
A. Please send an email to staff@insulators16benefits.org , or contact the Trust Fund Office at (925) 398-7042
or Toll Free at (844) 685-6409.
Q.How do I find a dentist or find out if my dentist participates with Delta Dental or United Concordia Dental?
A. Please visit www.deltadental.com or www.unitedconcordia.com.
Q.If I have Medicare, who does my provider submit the claim to?
A. When Medicare is primary, your provider will need to submit to Medicare first. Upon Medicare's payment/denial, your provider will need to submit the payment/denial to the Heat & Frost Insulators Local 16 Trust Funds at PO Box 1618, San Ramon, CA 94583. You can inform your provider that Medicare claims may be received electronically through a Medicare Crossover Clearinghouse as well if they do not wish to send in a paper claim.