Friday, July 23, 2021

Frequently Asked Health Care Questions


Q. Who should I call if I have questions about my eligibility? 
A. Please contact the Administrative Office at (408) 588-3753 or (877) 885-3753.
Q. What am I required to do when I become eligible for Medicare? 
A.

If you are retired, you must elect Medicare Parts A and B in order to ensure full benefits under the Plan. Your coverage will be coordinated with Medicare, meaning Medicare will become the primary payer for your hospital and medical claims and this Plan will be your supplemental coverage. You will receive a Medicare Supplement Card from the Plan to be used in addition to your Medicare card when you go to the doctor. 

Q. Why can't I see the status of a certain claim? 
A. One of the most common causes of not being able to view the status of a claim is the provider has not yet submitted the claim. This may be due to the provider submitting the claim to the wrong address, or it may simply have to be re-submitted. You may call your service provider and inform them that they may need to re-submit a particular claim. 
Q. What am I required to do if I am getting a divorce? 
A.Please call the Administrative Office and advise the Eligibility department that you are getting a divorce or are already divorced. You must submit a complete copy of your Final Judgement of Dissolution of Marriage. 
Q. How can I find out why a claim was not paid? 
A. You can view the Explanation of Benefits (EOB) for each claim that has been received. On this EOB, under Reason Code, it will explain the reason why an entire claim or a line item was denied.  If you need further explanation you may call the Administrative Office at (408) 588-3753 or (877) 885-3753.
Q. What number can I call to check the status of a claim?
A.Please contact the Administrative Office at (408) 588-3753 or (877) 885-3753.
Q. How do I obtain replacement benefit cards? 
A.Please contact the Administrative Office at (408) 588-3753 or (877) 885-3753. 
Q. How do I find a California participating Blue Cross PPO provider? 
A.A provider search can be performed on the Blue Cross website at www.anthem.com/ca.
Q. What address do I use to send my claims? 
A.
•Medical (Anthem Blue Cross)
P.O. Box 60007
Los Angeles, CA 90060
•Vision (IBEW 234)
P.O. Box 2458
San Jose, CA 95109-2458

Q. How do I get reimbursed if I paid out of pocket for a prescription? 
A.Please contact SavRx at (800) 228-3108.
Q. How do I sign up for mail order prescriptions?
A.Please contact SavRx at (800) 228-3108. 
Q. What is required to add a new dependent to my plan? 
A. 

You must fill out an enrollment form. You can download an enrollment form from this website under "Forms" and mail or fax it to the Plan Office. The following documents must be submitted with the enrollment form:

-Spouse - Copy of your marriage certificate.
-Child - Copy of the birth certificate. If you are enrolling a newborn, a hospital certificate will be valid for 90 days from the date of birth and then a copy of the original birth certificate must be submitted.
 

NOTE: If you are adding a newborn or new spouse, you must submit the enrollment form within 90 days from the date of birth or marriage. 

-Step-Child - Proof of custody: Prior divorce decree that states who has primary physical custody of the child or tax returns showing you claim the child.
-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 Plan office will need a copy of the final legal adoptions documents. 
Q. How do I find a pharmacy in my area? 
A. Participating pharmacy information may be obtained by visiting the SavRx website at www.savrx.com  and clicking "Locations" or by calling SavRx directly at (800) 228-3108.  
Q. How long does it take for claim status to show on this website? 
A. Normally, you will see claim status about 15-25 days following receipt of the claim. 
Q. Who do I call if I have a question about my prescription benefits? 
A. Please contact SavRx at (800) 228-3108. 
Q. What benefits are available to me if I become disabled? 
A. If you are an Active Employee with five years (60 months) of continuous coverage who had coverage on the date you became disabled you are receiving Workers Compensation Benefits, Social Security Benefits or State Disability Benefits, you may submit a request in writing to the Board of Trustees that you be placed on the Temporarily Disabled List. Upon approval, you will be required to exhaust your reserve hours, if any, and then you will remain covered free of charge for a period not to exceed 12 months. You must provide proof continued disability on a quarterly basis while disabled.  
Q. What is considered an eligible dependent? 
A. 
  • Your lawful spouse.
  • Your natural children (until age 26 if they are not eligible to enroll under his/her employer-sponsored health plan and are unmarried or, if married, are not eligible to enroll under his/her spouse's employer-sponsored health plan).
  • Your legally adopted children.
  • Any child to who the Covered Person is the legal guardian if: they are supported by the Covered Person, they are not covered under the Plan as another Covered Person's dependent and they are not on active duty in any armed forces. 
  • Unmarried children - regardless of age - who are totally disabled; however the Board of Trustees may establish an age limit at any time in the future for such disabled adult children and/or require additional premiums for such coverage or provide for any other special rules.
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, they will then need to submit to IBEW 234 at P.O. Box 2458, San Jose, CA 95109-2458. 
Q. When do I become eligible for benefits? 
A. The initial effective date of coverage is the first day of the second month following the month in which an employee has completed a total of at least 300 hours of work, reported on and paid to the Trust, from one or more contributing employers. 
Q. What if I don't work enough hours to gain eligibility? 
A. 

While you are working, any hours you work over 120 hours per month will accumulate in a Reserve Hour Bank up to a maximum of 600 hours to use to maintain your coverage if your work hours fall short or you become unemployed.   

Q. How do I check the balance on my HRA (Benny Card)? 
A. 

To check the balance on your Benny Card please visit: http://my.wexhealthcard.com/   

For more information about HRA Benny Cards please scroll over the Documents tab, click on Health Care and under Recent Mailings you will find a link with more information. 

Q. What is the Wellness Plan? 
A. Information regarding this can be found by scrolling over the Documents tab, clicking on Health Care and under Recent Mailings you will find a link with more information. This notice also explains how you can participate & what benefits you will receive if you complete the requirements by November 30, 2017. Additionally, http://www.moverewellness.com will have information.  

   
Q. Can I get reimbursed from my HRA for eligible expenses that I paid out-of-pocket?
A. 

Yes. For any eligible expense paid for out of pocket that you wish to get reimbursed from your HRA, simply submit a claim form to the Trust Fund office. This claim form can be found under the documents tab, find the healthcare forms section and click on the HRA (BennyCard) Claim Form. Please keep in mind any place where your BennyCard may not be accepted and you wish to purchase an eligible item using HRA funds, you may pay out of pocket and submit the form for reimbursement.