Thursday, May 28, 2020

Frequently Asked Health Care Questions


Q. When do I become eligible for benefits?
A. Coverage will begin the first day of the second month following the month that the member accumulates 300 work hours within twelve consecutive months.
Example of when coverage would begin:
If the 300 qualifying hours are completed in April, coverage would begin June 1st
Please note: Motorshop and Subscription agreement members' initial eligibility is the first day of the second month of employment (They do not have to qualify with 300 hours).
Q. How do I maintain my monthly health care coverage?
A. After you meet your initial eligibility requirement of 300 hours worked in a 12 consecutive month period, you must have at least the Actual Monthly Participant Cost (AMPC) per month in your Hour Bank to maintain your benefits. Effective with October 2018 eligibility the AMPC amount is $1846.00 per month.
Also, please note that you must pay the buy up charge if you are covered under either the UHC or indemnity (Anthem Blue Cross) medical plans.
                  
Q. What if I don’t work enough hours to gain eligibility for the month?
A.

You can accumulate a Reserve Dollar Bank up to a maximum of $11,076.00 (6 months x the Actual Monthly Participant Cost) to use to maintain your coverage if your work hours fall short or you become unemployed. 

Q. If I have exhausted my Dollar Bank reserve, are there any other options to continue my coverage by paying for it?
A. Yes, please see the options below that may be available to you:

    Gap Payment For months where the employer contributions and your Dollar Bank do not cover the Actual Monthly Participant Cost (AMPC), you may make a “Gap” payment to bring your Dollar Bank reserve up to the level of the AMPC to continue your coverage under the plan for that month. Note: Your Dollar Bank balance must be at least ½ of the AMPC in order to be eligible to make a “Gap” payment. Self-Payment This payment amount is 50% of the AMPC. In order to be eligible to make this type of payment, you must have 12 months of eligibility under the Plan within the last 24 months and you must be on the Out of Work List (unless you are disabled or a leave of absence was approved by Board of Trustees). COBRA If you are not eligible to make a Gap payment or Self-Payment, you may qualify to continue your coverage under the COBRA plan. You and your dependents may be required to pay the full cost of the coverage plus two percent for administration in order for your coverage to be continued.
    Please note that for numbers 1 and 2 above, and if you are a Participant of the indemnity (Anthem Blue Cross) or United Healthcare (UHC) medical plans, you will be required to pay the buy up charge in addition to the payment described.
    Q. Will my coverage continue if my employer is delinquent?
    A. Your coverage may continue for up to a maximum of 2 months (for the same employer within a 12 month period) by the 60 Day Protection Plan funded by the Alameda County Electrical Industry Service Corporation. You must meet the eligibility qualifications in order to get this coverage. Please refer to your Summary Plan Description booklet for more information about this benefit and the rules that apply.
    Please note that Participants participating under the Maintenance, Motorshop and Subscription Agreements are not eligible for the 60-Day Protection Plan.
    Q. Are there any benefits available if I become disabled?
    A. If you become disabled, you may receive coverage at no charge for up to six months provided you have acquired twelve months of eligibility within the last twenty-four months. Please refer to the Summary Plan Description booklet for eligibility rules.
    Q. I am eligible to take time off work under the Family Medical Leave Act (FMLA)?
    A. You and your employer must qualify under the FMLA guidelines. You will need to contact your employer for this information. If you and your employer qualify, your employer may be responsible for making contributions for your health care coverage while you are off work on FMLA.
    Q. Will my family and I be covered if I’m called to active military duty?
    A. If you are called to active duty, you can choose to continue coverage for up to a maximum of 24 months from the date service commences:
      If your leave is 31 days or less, coverage will be continued at no cost to you (Dollar bank will be frozen). If your leave is more than 31 days, you can elect to continue coverage by:
        Exhausting your Reserve Dollar Bank Making monthly Self-Payments
        Please contact the Trust Fund Office at 1-888-512-5863 for additional information and to ask any questions you may have regarding your benefits.
        Q. Who is considered an eligible dependent?
        A.
          Your Lawful Spouse California Registered Domestic Partner Children who are dependent upon you support Children can include:
            Your natural children Your legally adopted children Your step-children Child for whom you have been appointed legal guardian by court Foster children Your Domestic Partner’s children
            (Children are covered through first day of the month following their 26th birthday. In order to add a new dependent onto your plan, you will be required to submit documents from the following list:
              Spouse – copy of your marriage certificate Domestic Partner – copy of court documents showing registration in California Child – copy of your child’s original birth certificate Child that does not reside in your home – copy of child’s birth certificate along with copy of Qualified Medical Child Support Order. Step-child – copy of child’s original birth certificate along with proof that step-child resides with member on a full-time basis. Adopted child - copy of legal decree of adoption or letter from adoption agency stating the date child was placed in member’s home for purpose of adoption. Child for whom you have been appointed their legal guardian – copy of legal guardianship documents (if temporary guardianship, status updates will be required every 6 months). SS # for all dependents
              Q. How do I add my new baby or spouse to my insurance plan?
              A. You are required to enroll your new dependents within 30 days of birth, marriage, or other event which makes a dependent eligible. You must also fill out an Enrollment Form. You can download one off of this website located under “Health & Welfare Documents” and mail it into the Trust Fund Office with the required documentation.
              Q. Whom should I call if I have a question about my eligibility?
              A. Call the Trust Fund Office at (925) 208-9996 or (888) 512-5863.




              Benefits

              Q. When can I choose what plan I would like to enroll in?
              A. When you become eligible for benefits a New Member Packet will be sent to you with information regarding your benefits and the required forms to be filled out.
              Q. After I choose a medical plan, am I able to change it in the future?
              A. The Plan maintains a "rolling" Open Enrollment. You have the opportunity to make a change your Medical and/or Dental plan anytime during the year, as long as you have not made changes in the last consecutive 12 months.
              Q. What benefits are available to me as an active participant through the IBEW Local 595 Health & Welfare Plan?
              A. The Plan provides for the following benefits:
              • Medical & Hospital Benefits through one of the following:
              • Anthem Blue Cross PPO Indemnity Plan (requires Buy-up)
              • Anthem Blue Cross Alternate Deductible PPO Indemnity Plan
              • Kaiser HMO
              • United Healthcare HMO (UHC)
              • Prescription Drugs through one of the following:
              • OptumRx Prescription Drug Card program for participants under the Anthem Blue Cross options and UHC
              • Kaiser pharmacy for Kaiser participants
              • Dental Benefits (except for participants enrolled in the Anthem Blue Cross Alternate Deductible PPO Indemnity Plan) through one of the following:
              • Delta Dental
              • United Healthcare Dental
              Vision Benefits (except for participants enrolled in the Anthem Blue Cross Alternate Deductible PPO Indemnity Plan) provided through Vision Service Plan (VSP) Death Benefit of $15,000 Accidental Death & Dismemberment Benefit of up to $15,000 Member Assistance Program (MAP)
              Q. Is there a pre-existing Clause?
              A. No, there is not.
              Q. What benefits are available for chemical dependency/mental health?
              A. Benefits are available at the same level as for other illnesses.
              Q. How do I find a Blue Cross Provider?
              A. Go to www.anthem.com/ca. , register as a visitor and click on “find a doctor”. Follow the prompts for the type of provider you are looking for.
              Q. How do I utilize my vision benefits?
              A. Please note that there are no benefit cards. Please visit the Vision Service Plan ("VSP") website by clicking the following link to determine if your doctor is a VSP provider: VSP Website. Your VSP group number is 409401.
              Please contact VSP at (800) 877-7195 (Lenses and frames are available every 24 months).
              Q. I have a question about my co-payment, who do I call?
              A. Please call the Trust Fund Office at (925) 208-9996 or (888) 512-5863. If you are enrolled in a United Healthcare (UHC) or Kaiser HMO, you may also call UHC at (800) 624-8822, or Kaiser at (800) 464-4000.
              Q. How much are my Prescription co-pays?
              A. If you are covered under an Anthem Blue Cross Indemnity medical plan option, please refer to your Summary Plan Description (SPD), contact the Trust Fund Office or contact OptumRx at 800-788-7871 to determine the exact amount of your prescription co-pays.
              If you are a Participant on the Kaiser medical plan, please refer to your Kaiser summary of benefits for exact information regarding your prescription co-pays.
              Q. How do I find a local pharmacy?
              A. Please visit www.optumrx.com . Login is required for processing.
              Q. How do I obtain a replacement Medical card?
              A.
              • For Blue Cross Plans, please call the Trust Fund Office at (925) 208-9996 or (888) 512-5863.
              • For Kaiser Plans, please call (800) 464-4000.
              • For UnitedHealthcare Plans (including plans formerly known as PacifiCare), please call (800) 624-8822
              Q. How do I get a Mail Order Prescription?
              A. Visit www.optumrx.com or call the Trust Fund office at (888) 512-5863 for assistance if you are a Participant of either the Indemnity (Blue Cross) or UnitedHealthcare medical plans.
              If you are enrolled in the Kaiser medical plan, call the customer service department number listed on your card.
              Q. How do I utilize my dental benefits?
              A. -if you are enrolled in Delta Dental, no ID cards are issued. You may visit the Delta Dental of California website to determine if your doctor is a Delta Dental of California provider: www.deltadentalins.com. Your Plan is the Delta Dental Premier and your group number is 3374. You may also use the Delta Dental of California website at www.deltadental.com to find a dentist!
              if you are enrolled in United Health Care Dental, please contact UHC at (800) 999-3367.
              Q. How do I find a dentist?
              A. Please call Delta Dental at (800) 765-6003 or visit their website at www.deltadentalins.com. You can utilize the find a dentist feature at the Delta Dental website for more information. Please note that your Delta Dental plan is Delta Dental Premier. If you are a Participant of the UHC Dental Plan visit their website at www.myuhcdental.com to locate a UHC dentist near you.


              Retiree Coverage

              Q. How do I know if I am eligible for Retiree Health and Welfare coverage?
              A. Refer to the Summary Plan Description for eligibility rules or contact the Trust office at (888) 512-5863.
              Q. If I am retired, what are my Medical/Rx coverage options?
              A. If you are Medicare eligible, you may enroll in Kaiser Senior Advantage or United Healthcare National PPO Medicare Advantage. If you are not Medicare Eligible, you may enroll in Kaiser HMO, United Healthcare (UHC), or the Indemnity (Anthem Blue Cross) Plan. Prescription drug benefits for the Indemnity and UHC plans are provided through OptumRx drug card program. Kaiser provides the prescription drug benefits for members enrolled under that program. Please call the Trust Fund Office with any questions.
              *Please note: Not available for Local 595 Motor Shop Retirees, their dependents, or surviving spouses.
              Q. As a retiree, what do I need to do when I become eligible for Medicare?
              A. You must enroll in both Medicare Part A and Part B as soon as you are eligible for Medicare. This Plan's coverage becomes supplementary to Medicare coverage.
              If you are enrolled in one of the HMO plans (Kaiser or United Healthcare), you must also enroll into their Medicare plan (Kaiser Senior Advantage or United Healthcare National PPO Medicare Advantage). Please contact the Trust office for the appropriate forms.


              Medical Claims

              Q. What number do I call for claim status?
              A. For Anthem Blue Cross Indemnity plans, please call the Trust Fund Office at (888) 512-5863 or (925) 208-9996. For Kaiser or United Healthcare (UHC) plans, please contact the customer service number listed on the back of your card.
              Q. How do I view my claims?
              A. After you log in, if you are enrolled in the Anthem Blue Cross Indemnity PPO plan, you’ll see your claims information under the ‘Member Information’ menu item. If you have any questions regarding the status of a claim, please do not hesitate to contact the Trust Fund Office at 1-888-512-5863.
              If you are enrolled in United Healthcare (UHC) or Kaiser HMO, please contact either UHC at (800) 624-8822 or Kaiser at (800) 464-4000.
              Q. What if I do not see the status of a medical claim I am checking on?
              A. If you are covered under an Anthem Blue Cross PPO Indemnity medical option, one of the most common reasons for not being able to view a claim status is that the provider has not submitted the claim. Or it may simply have to be resubmitted. You may call your provider of service and inform them that they may need to re-submit the particular claim. Please note that viewing a claim through www.ibew595benefits.org is available to Indemnity (Blue Cross) Participants only.
              If you are a United Healthcare (UHC) or Kaiser medical plan Participant, we recommend that you contact either UHC or Kaiser directly to ascertain the status of your claim(s).
              Q. How do I know the reason why a claim has not paid?
              A. If you are covered under an Anthem Blue Cross PPO Indemnity medical option, once your claim is processed you will be sent an Explanation of Benefits (EOB). On this EOB, under Reason Code, it will explain the reason why an entire claim or line item has not been paid or has been denied. You may also view your EOB online after you log into your participant account. If you need further explanation, you may call the Trust Fund Office if you are a Participant in the United Healthcare (UHC) or Kaiser medical plans, you can check with either UHC or Kaiser for more information on the status of your claim(s).
              Q. Where do I submit a medical claim for reimbursement if I’ve already paid out of pocket?
              A. IBEW local 595
              PO Box 3420
              San Ramon, CA 94583
              Q. How long should I wait for claim status to show on the website?
              A. Normally, you will see claim status in about 15-25 days upon receipt of the claim.


              Health Reimbursement Account (HRA) Benny Card

              Q. What is a Health Reimbursement Account?
              A. An Health Reimbursement Account or HRA, is a type of health benefit plan established under IRS Section 105 that provide for reimbursement to employees of allowable covered healthcare expenses. The account is solely funded by contributions that employers are required to make on your behalf under your Collective Bargaining Agreement.
              Q. What is the Benny Card?
              A. The Benny Card is a special-purpose pre-paid debit card that is linked to your individual HRA that allows participants and their eligible dependents to electronically access your account to pay for allowable covered healthcare expenses.
              Q. How does the Benny Card work?
              A. The Benny Card works like a MasterCard or Visa debit card with the value linked to your individual account. When a participant or their eligible dependent has allowable eligible expenses at a business that accepts MasterCard or Visa debit cards, they simply use the card instead of cash. The amount of the qualified purchases will be automatically deducted from their account and the pre-tax dollars will be electronically transferred to the provider/merchant immediate payment. The Card eliminates most out-of-pocket cash outlays and paperwork, as well as the need to wait for reimbursement checks.
              Q. Do I just use the card and that's it?
              A. In most cases yes, but because the funds provided through an HRA's debit card such as Benny Card are tax-free, IRS regulations require that every use of the Benny Card be "substantiated", or validated as an eligible, covered expense under the Plan. While many of the Benny Card transactions such as co-payments can be automatically substantiated/verified, other services that might not be allowable covered expenses so you might be asked to submit documentation to substantiate/verify the charges. This is now required by the IRS- the Fund cannot make exceptions.
              Q. If my services are not automatically substantiated what do I need to provide?
              A. While many of the Benny Card transactions such as co-payments can be automatically substantiated/verified, other services that might not be allowable covered expenses. Expenses provided through a masseuse or services that might be cosmetic in nature will require that you provide substantiation that the service is an allowable covered expense. In these cases, you will receive a request from the Plan Office asking you to provide a copy of an itemized receipt or Explanation of Benefits (EOB) which includes:

              • Name of the member for whom the charges relate
              • Name of the provider
              • Description of the service or items purchased
              • Date the services were provided
              • Amount of expense, service charge and/or out-of-pocket expense not paid by insurance

              Please note that credit card or cash receipts, cancelled checks and balance forward billing statements (unless itemized with the above information) are not considered adequate substantiation. You might also be asked to provide substantiation for services that might appear to be similar in nature but every service is unique and as a result it might be necessary for you to provide substantiation on each charge.
              Q. I don't remember having to provide substantiation in the past. Why now?
              A. HRA funds are tax-free if they are used for allowable covered expenses but if they are used for services that are not allowable covered expenses as defined by the IRS, then those funds are taxable. In the past, enforcement had primarily through individual tax audits. IRS regulation and enforcement now requires that the Plan take a more active role in enforcing these regulations.
              Q. What happens if I can't substantiate or validate my Benny Card charges?
              A. If you are unable to provide substantiation that the Benny Card use was for an allowable covered expense, you will be asked to refund the amount of the Benny Card usage, which will be credited to your HRA. If you fail to repay the ineligible expense, your Benny Card will be suspended until repayment is received.
              Additionally, if your card is in suspension and your repayment has not been received as of the end of the calendar year, you may receive an IRS Income Tax Form 1099 declaring as income the amount of the purchase(s) that resulted in suspension of your Benny Card.
              Q. Who can use my Benny Card and who can I utilize my Benny Card on behalf of?
              A. In addition to yourself, all eligible dependents that you have under the IBEW Local 595 Health & Welfare may use the card for allowable covered expenses incurred by you or your dependents.
              Q. How do I find out what the balance in my account is?
              A. You can access the current balance and the status of your Benny Card account through www.mybenny.com. You can also contact the Member Services Department at the Plan Office.