Wednesday, December 4, 2024

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 (702) 415-2188.
Q.How do I maintain my monthly Health Care coverage?
A.You must have an employer contribution submitted on your behalf each month, or make payment as a self-pay Employee, 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 the Health Care coverage through the Retiree, Active, or COBRA Continuation programs.
Make Check Payable & Remit to:
Electrical Workers Local 357 Trust Funds
P.O. Box 51349
Los Angeles, CA  90051-5649

If you wish to make a self-payment online, you may do so with your checking account.  After you log into the participant website, www.ibew357benefits.org, please click on the "Member Benefits" heading, then click "Self Payment".  Be sure to review the "My Self Payment" information section and click "Pay Now".  Enter your bank/checking account information and click "Pay Now" at the bottom.  Your self payment history will appear on the screen.  Don’t try to pay too soon – your information won’t be there until a bill is generated. 

Q.Whom should I call if I have questions about my Health Care eligibility?
A.Please contact the Trust Fund Office at: (702) 415-2188.
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 on the coverage 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 Declaration of Domestic Partnership with a copy of the State of Nevada 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.How do I find State of NV Domestic Partner Information?
A.Please visit State of NV Domestic Partner Information.
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 getting a divorce or have already gotten divorced. You will also need to submit a FULL copy of your Dissolution of Marriage Judgment and QDRO (Qualified Domestic Relations Order) to this office.
Q.Who is the Prescription Drug Benefit Manager?
A. MagellanRx.
Q.How can I contact the Prescription Drug Benefit Manager?
A.(800) 424-5727.
Q.How do I find a physician or find out if my doctor participates with Anthem? 
A.Call (702) 415-2188 or visit www.anthem.com. When visiting the Anthem website, select menu and then choose Find a Doctor. In the search as a member section, enter your id number or the 3 letter alpha prefix - QEW, then click the continue button. Next you can select a type of doctor, place or name, then select search.
Q.If a service I need requires Prior Authorization, who do I (or my provider) contact?
A.Innovative Care Management (ICM) (800) 862-3338.
Q.If I need to utilize Mental Health or Substance Abuse benefits, who do I contact?
A.EAP (800) 873-2246 or (702) 364-1484, available 24 hours a day, 7 days a week.
Q.How do I inquire about the status of my medical or dental claim?
A.First, you must log-in with your username and password. After log-in, hover over "Member Benefits" and then click "Healthcare Claims" from the drop down menu. If you are on the HMO Dental plan (Nevada Dental Benefits) please call them at (702) 478-2014.
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 a single line item. If you need further explanation you may call or email the Trust Fund Office at (702) 415-2188 or staff@ibew357benefits.org .
Q.How do I obtain a replacement Medical Card?
A.Please send an email to staff@ibew357benefits.org or contact theTrust Fund Office at: (702) 415-2188.
Q.How do I find a dentist or find out if my dentist participates?
A.If you are on the Indemnity Dental (Diversified Dental) please visit www.ddsppo.com and if you are on the HMO Dental (Nevada Dental Benefits) Please visit www.nevadadentalbenefits.com or call (702)478-2014