Saturday, August 17, 2019

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 continue with COBRA Continuation Coverage. Please contact the Trust Fund Office at (206) 518-9730 or Toll Free at (844) 344-2721.

Q.

How do I maintain my monthly Health Care coverage?

A.

You must have employer contributions of a specified amount determined by your Collective Bargaining Agreement and coverage election you have choosen or you can elect COBRA Continuation Coverage to maintain Health Care Coverage.

Q.

How do I make a payment towards the continuation of my Health Care coverage?

A.

You may elect COBRA Continuation Coverage to continue Health Care Coverage. You may mail your check or money order to: The Employee Painters' Trust P.O. Box 24844 Seattle, WA 98124-0844

Q.

Whom should I call if I have questions about my Health Care eligibility?

A.

Please contact the Trust Fund Office at (206) 518-9730 or Toll Free at (844) 344-2721.

Q.

Who are my eligible dependents?

A.

  • Your lawful spouse
  • Your natural children up to age 26
  • Your legally adopted children up to age 26
  • Your step-children up to age 26
  • A foster child up to age 26
  • Disabled children who are primarily dependent upon your support and maintenance
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 covered 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 to the Trust Fund Office. Legal documentation required: * Spouse - Your certified marriage certificate * Natural/Step-Child - Your child's certified birth certificate * Adopted Child - Copy of court order of adoption or placement for adoption * Legal Gaurdianship documents from the court

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 in the process of getting a divorce or have already gotten divorced. You will also need to submit a FULL copy of your Dissolution of Marriage Judgment, QDRO (Qualified Domestic Relations Order) and child custody order assigned by the court.

Q.

How do I obtain a replacement Medical and Prescription Card?

A.

Request through the messaging feature of this website or by contacting the Trust Fund Office at (206) 518-9730 or (844) 344-2721.

Q.

How do I inquire about the status of my medical claim?

A.

Inquire through the messaging feature of this website or by contacting the Trust Fund Office at (206) 518-9730 or (844) 344-2721.

Q.

Who is the Prescription Drug Benefit Manager?

A.

EnvisionRx

Q.

How can I contact the Prescription Drug Benefit Manager?

A.

(800) 361-4542

Q.

If a service I need requires Prior Authorization, who do I (or my provider) contact?

A.

Innovative Care Management at (800) 862-3338

Q.

If I need to utilize Mental Health or Substance Abuse benefits, who do I contact?

A.

Aetna can assist with finding a contracted provider at (888) 632-3862 and the Trust Fund Office can be messaged through this website or called at (206) 518-9730 or (844) 344-2721 to provide benefit information.

Q.

How do I find a dentist or find out if my dentist participates with Careington Dental at (800) 290-0523

A.

Contact Careington Dental at (800) 290-0523

Q.

If I have Medicare, who does my provider submit the claim to?

A.

Claims can cross over electronically from your provider through a HDM clearing house or if providers choose to submit hard copies they can be mailed to: Employee Painters’ Trust, PO Box 1618, San Ramon, CA, 94583.

Q.

Who are my Vision benefits through and how can I contact them?

A.

Vision benefits are provided through VSP and they can be contacted at (800) 877-7195 or at www.vsp.com