Wednesday, April 17, 2024

Frequently Asked H&W/VEBA Questions

Q. When do I first become eligible for benefits?
A.If you are a new employee of a contributing employer, you will become eligible on the first day of the second calendar month following a period not to exceed six months during which you have accumulated at least 125 hours in your hour bank.

Example of when coverage would begin: Qualifying hours are worked in May Hours are reported to the Trust Fund in June (Skip Month = June) Coverage becomes effective in July. 
Q. What documents are required to add a new dependent to my Plan?
  • Completion of an Enrollment Form and supporting documentation for each dependent. Please see below for required documents.
  • Spouse - copy of your marriage certificate.
  • Domestic Partner - Compliance with domestic partner laws of the state or compliance as such by the City of and County of San Francisco.
  • Child - copy of your child's birth certificate. *If you are enrolling a newborn, a hospital certificate will be good for 90 days from the date of birth, and then we will need a copy of the original birth certificate.
  • Step-child - copy of child's birth certificate. If your spouse is not on the Plan, then we'll need a copy of your marriage certificate to prove the child is your step-child. 
  • Adopted-child - If you are enrolling this child in Kaiser, we will need a copy of the legal adoption papers from the court or a letter form the adoption agency stating the date the child was placed in the home if the legal process has not been completed yet. Upon completion of legal adoption, the Plan office will need a copy of the legal adoption papers.
  • Disabled/Handicap Child - A copy of the child's birth certificate and disability certification from doctor.
Q. Who are my eligible dependents?
  • Your lawful spouse or domestic partner.
  • Your unmarried natural children
  • Your legally adopted children
  • Your step-children
  • Dependent children are covered until the age of 26 provided they are not eligible to enroll in another sponsored plan (other than that of a parent)
Q. Will my child who is age 19 to 26 be covered under the Plan?
A. Dependent children are covered until the age of 26 provided they are not eligible to enroll in another employer sponsored plan (other than that of a parent).
Q. Where do I mail self-payments?
Solano & Napa Counties Electrical Workers
PO Box 45005
San Francisco, CA 94145-0005 
Q. How do I add my new baby or spouse to my insurance plan?
A. You must fill out a Kaiser Enrollment Form. You can download one off of this website located under "Forms" and mail it into the Trust Fund Office to the correspondence address above. If you are adding a newborn or new spouse, you must submit it within 30 days from the date of birth or marriage. Please attach all required documentation. 
Q. Where do I mail correspondence? 
Solano & Napa Counties Electrical Workers
PO Box 1306
San Ramon, CA 94583 
Q. Whom should I call if I have questions about my eligibility? 
A. The Plan Office at: (925) 208-9980 or (866) 544-9880
Q. Does the Plan provide coverage if I am called to "active" duty in the Military?
A.In accordance with the Uniformed Services Employment and Reemployment Rights Act (“USERRA”)(38 U.S.C. § 4317), if you are on military leave you are entitled to continuation coverage rights similar to those described under COBRA. This continuation of health and welfare coverage applies to both you and your dependents. You or your dependent may elect continuation health and welfare coverage. The coverage will be limited to a term that ends on the earlier of twenty-four (24) months from the date military service begins or the date on which USERRA requires you to offer to return to civilian employment.
Q. Are there any disability benefits available from the Plan?
A.No, but coverage can be continued by your reserve hours, self-payments or COBRA payments. If you have been awarded a Social Security Award or have submitted an application for one within 6 months of the onset of disability, self-payments can be continued longer than the regular 12 month period. Please call the Fund Office for more information. 
Q. What if I live outside the Kaiser area? 

During Open Enrollment or following your retirement you can elect to waive Kaiser coverage and obtain coverage from a carrier of your choice. The Fund will reimburse you up to a maximum amount which is determined by the Board of Trustees. You must provide proof of coverage and payment in order to receive reimbursement. Reimbursements will be made on a quarterly basis, to cover a maximum of three months payments.

** If you are an "active" employee, this waiver must be approved by the Board of Trustees ** 

Q. If my coverage terminates due to insufficient hours, when will I regain coverage?
A. If your eligibility terminates due to insufficient hours in your hour bank, you will regain coverage on the first of the month after you have accumulated 125 hours in your Hour Bank. If you do regain eligibility within 12 months of termination, any hours in your Hour Bank will be cancelled and you will again have to satisfy the Initial Eligibility requirements to regain eligibility.
Q. Can I lose my account balance in the Accumulated Share or Supplemental Accumulated Share Accounts? ? 
A. Your balance(s) can only be lost if you die without eligible dependents under your Health & Welfare (a spouse or qualifying children that are considered your dependents under Internal Revenue Code rules). If there are no eligible medical dependents under your Health & Welfare coverage, the amount in your account at the time of death will be treated as plan income and distributed amongst remaining accounts. However, it will not be lost simply because you cease working in a category for which contributions are made to these VEBA accounts prior to retirement. There are no required years of participation in order for your accounts to remain active and available for your use or the use of an eligible dependent under your Health & Welfare coverage.
Q. How do I make a claim for reimbursement?
A. You need to submit a VEBA Reimbursement Claim Form to request reimbursement of qualified medical expenses. Remember, claims must be supported with receipts that identify the service or item purchased, the date of purchase, the provider, and the amount. Claim forms are available on the website or by contacting the Plan Administrator.
Q.What expenses may be reimbursed from my VEBA accounts?
A.To be reimbursable, an expense must:
  • Be incurred either before retirement from your SAS account or after retirement while you have a sufficient credit balance in the combined total of your SAS and AS accounts to cover the expense;
  • Be substantiated by filing a claim within 12 months of the date the expense was incurred, and providing evidence that an eligible medical care expense was incurred, and
    • Not be reimbursable from any other health plan or insurance, and
    • Be incurred by you and/or your dependents for medical care, as defined under the Internal Revenue Code (IRC)medical expense.  In general, medical care expenses include, but are not limited to, amounts for such things as hospitalization, doctors and dentists bills, and prescription or over-the-counter drugs. Such expenses also include amounts you pay for deductibles, co pays, coinsurance, as well as premiums for group health plan coverage, COBRA and Medicare Parts B, C, and D coverage. However, not all medical care expenses will be considered “eligible medical care expenses” that qualify for reimbursement under the Plan.
Q.When will I be considered retired in order to use my Accumulated Share (AS) account as well as any balance in my Supplemental Accumulated Share (SAS) account?
A.You will be considered retired when you retire under the Solano-Napa Counties Electrical Workers Retirement Plan or when you reach age 55 and cease work in the electrical industry and have exhausted your reserve hour bank. At retirement, both your Accumulated Share (AS) account and your Supplemental Accumulated Share (SAS) account will automatically be combined.
Q.What is the exception under the Plan that would allow me to use my Accumulated Share (AS) account balance prior to retirement?
A.In the event you become disabled before you retire (as evidenced by a Social Security Disability award, Workers Compensation determination, or State Disability Insurance benefit notice) you can use your Accumulated Share (AS) account as well as your Supplemental Accumulated Share (SAS) account prior to retirement.
Q.What is the difference between the two VEBA Plan Accounts - Accumulated Share (AS)/Supplemental Accumulated Share (SAS)?
A.Each eligible employee shall have an Accumulated Share (AS) account in the Plan. Depending on collective bargaining agreement classification, you may also have a Supplemental Accumulated Share (SAS) account. Your Accumulated Share (AS) can generally be used only when you retire. Your Supplemental Accumulated Share (SAS) account if any, can be used while you are still an active plan participant.