Tuesday, October 15, 2019

Frequently Asked Health Care Questions

Please note; not all the answers given are the same for Fencer members. If you are a Fencer please call the Fund office to find which apply to you, as well.
Q. When do I become eligible for health insurance coverage through the Health Fund? 
A. The current monthly insurance benefit cost is $850. A person will become eligible when their bank has reached $2,550, which is equal to $850 per month for 3 months.
Q. When will I receive my enrollment packet? 
A. Your insurance information packet will be sent to you in the middle of the month prior to the month in which you have accumulated $2,550 in your insurance bank. Please be sure to complete and return the forms, along with any requested documents, as soon as possible. You will NOT have coverage until you return these documents.
Q. What are the continuing eligibility requirements? 
A. $850 dollars per month is required to maintain your health & welfare coverage.
Q. If excess hours are worked in a month, is there a bank? 
A. Yes, there is a 12-month bank which is equal to $850 x 12 months, or $10,200. When your contributions for the month are not sufficient to meet the $850 requirement, the bank will be used to make up the difference for your eligibility.
Q. How do I maintain my health insurance when my bank is depleted? 
A. If your bank becomes depleted and your contributions fall short of the $850 requirement, a self-payment notice will be sent to you.
Q. Is there a limit to how many payments I can make for my coverage when I don’t have hours or enough in my bank?  
A. Yes, a participant can make 3 consecutive payments. After these 3 payments the participant will be sent a verification form to be filled out by an area business agent for the member to be able to make an additional 3 payments.
Q. How do I add my new child or spouse? 
A. In order to add a spouse or dependent child to your insurance, the Fund office must be notified within 31 days of a qualifying life even. If the Fund office is not notified within 31 days of the event open enrollment for adding a dependent is April 1st through April 30th. The documents required once the Fund office is notified will be an updated vital information form along with a copy of the Birth Certificate [for dependent children] and/or the Marriage License [for a spouse]. Step Children are not automatically eligible as a dependent child, the participant will need to send in legal documents stating the participants responsibility for the child to the Fund office for review. Children under the guardianship of a participant and foster children do not qualify for dependent benefits. In addition, we must have the Social Security number for everyone placed on your insurance.
Q. How long may children be covered under the Plan?  
A. A child will be covered until the end of them month of their 26th birthday, unless the child is totally and permanently disabled. If your child is permanently disabled, you must notify the Fund Office for continued coverage after the child turns 26 years of age. The Fund office will also require proof from the doctor of the dependent stating they are unable to work and will then be unable to provide themselves with insurance coverage. When a dependent loses coverage under the plan they will be offered COBRA.
Q. How long may children be covered under the Plan?
A. A child will be covered until the end of them month of their 26th birthday, unless the child is totally and permanently disabled. If your child is permanently disabled, you must notify the Fund Office for continued coverage after the child turns 26 years of age. The Fund office will also require proof from the doctor of the dependent stating they are unable to work and will then be unable to provide themselves with insurance coverage. When a dependent loses coverage under the plan they will be offered COBRA.
Q. How do I use the Health Plan?
A. For Hospital, Medical, Master Medical, Vision and Hearing present your BLUE CROSS BLUE SHIELD PPO card.
Q. What if my spouse also has medical coverage through his/her employer? 
A.

Coordination of benefits between Plans is as follows:

  1. The Plan under which the Health Fund participant is an employee is primary for that person.
  2. The birthday rule is used for insured dependent children. The Plan of the Parent whose birthday is first in the calendar year is primary for the dependent children.
  3. If in a married couple, one is actively employed and the other has Medicare coverage, the Plan for the actively employed spouse is primary. 
Q. In the case of divorce when would the ex-spouse’s coverage end?  
A. If a divorce takes place the member will have to notify the Fund office and will also have to provide a copy of the full divorce decree. After this is received the ex-spouse will be removed from the coverage effective the last day of the month the divorce accrued in. They will then be given the option to take up COBRA coverage.
Q. What happens if I fail to notify the Fund Office of my divorce?
A. If you do not send in the proper documentation, such as the full divorce decree, you are responsible for any charges or expenses billed to your health insurance for that dependent. The Fund office will not be able to remove the spouse from the coverage without first receiving the full divorce decree. Not notifying the Fund Office of changes in your dependent status is considered fraud, and you will be liable for payment of all unauthorized charges. For Prescription Drugs present your OptumRx Card For Dental Coverage present your DELTA DENTAL or GOLDEN DENTAL card (these cards are not sent to a participant automatically, you will need to follow the directions for the consumer toolkit provided in your insurance information packet to print an identification card. If you do not have or want a card you can be found in Delta Dental or Golden Dental’s system with your social security number.)
Contact the Fund Office at (248) 347-3100 or (800) 572-8553 regarding a change in beneficiary or other relevant information.