Friday, January 23, 2026

Frequently Asked Health Care Questions


Q. How do I attain eligibility under the Health Care Plan?
A.Initial Eligibility is 128 hours in one month to receive insurance coverage. A member is eligible the 1st day of the second month after the 128 hours are earned. For example if you worked 128 hours in January you would qualify for Insurance coverage March 1st. PLEASE NOTE - the last Sunday of the month is used for the cut off for reporting purposes.
Q. What if I don’t work enough hours to gain eligibility for the month?
A. To be eligible for insurance coverage under the I.B.E.W. Local 86 Health & Welfare plan you must work 128 hours in one month to qualify. If you work at least 118 hours in one month you can self contribute up to 10 hours to bring your total hours to the 128 requirement. You will be sent a letter if your hours worked meet this criteria. If you are interested in self contributing to make up the hours short you would then contact the Fund Office to find out the required payment. The amount due will be calculated by hours short times the hourly contribution rate of $10.73.
Q. How do I maintain my monthly Health Care coverage?
A. To maintain coverage you must be credited with 117 hours of work for the second prior month or has not been credited with the following number of hours of work:
350 hours of work for the consecutive 3-month period that ended with the second prior month
700 hours of work for the consecutive 6-month period that ended with the second prior month
1050 hours of work for the consecutive 9-month period that ended with the second prior month
1400 hours of work for the consecutive 12-month period that ended with the second prior month
Q. How do I make a payment towards the continuation of my Health Care coverage?
A. The Fund Office must receive a payment from you by the required due date for the hours you were short that you received a bill for or you can use your Supplemental account to pay the bill. In order to use the Supplemental account you need to fill out the Premium Payment Form the found under the Insurance forms.
Q. Will my child (ren) who is/are age 19 through 26 be covered under the Plan?
A. If they meet the qualifications as a dependent under the Plan they can be covered up until age 26.
Q. How do I add my new baby or spouse to my insurance Plan?
A. If they meet the qualifications as a dependent under the Plan you would need to supply the Fund Office with a copy of their social security number, birth certificate or Marriage certificate and fill out an EBCBS enrollment form.
Q. Do I need to notify you if I’m getting divorced?
A. You must submit a copy of your divorce decree to the office ASAP to remove your ex from the Plan. Once you are legally divorced they cannot stay on your policy. If you fail to notify the Plan office immediately you may be financially and legally responsible for any health care expenses incurred during the period of ineligibility.
Q. How do I obtain a replacement EBCBS Card?
A. Contact EBCBS at (877) 253-4797 and request a new card.
Q. How do I inquire about the status of my medical claim?
A. You would contact EBCBS at (877) 253-4797
Q. I am being told by my provider’s office that I don’t have coverage. What could possibly be wrong?
A.
  1. You qualified for insurance but did not fill out the application.
    • Each time you re-qualify for insurance coverage you must fill out a new Excellus Blue Cross Blue Shield Enrollment Form.
  2. You have an old Excellus Blue Cross Blue Shield insurance card in your wallet.
    • If the account number doesn’t begin with VYA and the effective date is prior to 11/1/12 then you have an old card.
  3. You did not work enough to qualify for coverage.
    • The Plan requires 128 hours in one month for initial eligibility. A member is allowed to purchase 10 hours of the 128 hours if short.