Wednesday, May 12, 2021

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 a self-payment directly to the Plan, or you may be eligible to continue with COBRA Continuation Coverage. Please contact the Trust Fund Office at (925) 398-7043 or Toll Free at (855) 704-5273.
Q. How do I maintain my monthly Health Care coverage?
A. You must have employer contributions of a specified amount set by the Plan each quarter, submit a self-payment or elect COBRA Continuation Coverage 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 Health Care coverage through the Self-Payment, COBRA Continuation or Retiree programs. You may mail your check or money order to:

I.A.T.S.E. Local 16 Trust Funds
PO Box 398439
San Francisco, CA 94139-8439
Q. Whom should I call if I have questions about my Health Care eligibility?
A. Please contact the Trust Fund Office at (925) 398-7043 or Toll Free at (855) 704-5273.
Q. Who are my eligible dependents?
A.
  • Your lawful spouse
  • 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 the "Documents" tab and mail it to the Trust Fund Office.

Legal documentation required:
  • Spouse – copy of your marriage certificate
  • Natural/Step-Child - Copy of your child's certified birth certificate
  • Adopted Child - Copy of court order of adoption
Q. Whom should I contact if I'm getting a divorce and what documents do I need to submit?
A. Please call the Trust Fund Office and advise the Eligibility and Pension Departments that you are in the process of 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 child custody order assigned by the court.
Q. How do I obtain a replacement Medical and Prescription Card?
A. Please contact the Trust Fund Office at (925) 398-7043 or Toll Free at (855)704-5273.
Q. How do I inquire about the status of my medical claim?
A. You can log-in to this website with your username and password. After log-in, hover over "Member Benefits" and then click "Healthcare Claims" from the drop down menu.
Q. Who is the Prescription Drug Benefit Manager?
A. Optum Rx
Q. How can I contact the Prescription Drug Benefit Manager?
A. Call (800) 797-9791 or visit optumrx.com
Q. If a service I need requires Prior Authorization, who do I (or my provider) contact?
A. Anthem Cost Containment & Utilization Review (800) 274-7767
Q. If I need to utilize Mental Health or Substance Abuse benefits, who do I contact?
A. Teamsters' Assistance Program (TAP) (800)253-8326
Q. How do I inquire about the status of my medical or dental claim?
A. You can view your claims online on this website in the Member Benefits section or by calling the Trust Fund Office at (855) 704-5273.
Q. What if I do not see the status of a claim I am checking on?
A. Contact the Trust Fund Office to verify that information being used to submit the claim is correct.
Q. How do I know the reason why a claim has not paid?
A. By reviewing your Explanation of Benefits the reason will be listed as to why the claim has been denied. For further information please contact the Trust Fund Office.
Q. How do I obtain a replacement Medical Card?
A. Contact the Trust Fund Office to request a replacement card.
Q. How do I find a dentist or find out if my dentist participates with Cigna Dental Shared Administration DPPO Plus Network?
A. By calling (800) 797-3381 or by visiting cignadentalsa.com and selecting Cigna Dental Shared Administration - Dental PPO Plus.
Q. If I have Medicare, who does my provider submit the claim to?
A. Claims will cross over electronically from a Medicare clearing house, or claims can be mailed to: I.A.T.S.E. Local 16 Health and Welfare Trust Fund, PO Box 1618, San Ramon, CA 94583.