Here is some important information regarding your Benefits. Please read carefully:

IMPORTANT HEALTH COVERAGE TAX DOCUMENTS NOTICE OF RIGHT TO REQUEST TAX NOTIFICATION FORM 1095-B

This notice is intended to provide you with information related to obtaining a copy of your IRS Form 1095-B (health coverage) from the Central Midwest Regional Council of Carpenters Welfare Fund (CMRCC Fund). As a reminder, the IKORCC Welfare Fund merged into the Ohio Carpenters Health Fund as of 1/1/2025 and the Ohio Health Fund was renamed the CMRCC Fund. Form 1095-B provides you with information about your healthcare coverage, including who was covered, and when the coverage was in effect.

You do not need to file a Form 1095-B with your federal tax return, but some Participants may need the form to comply with state reporting requirements.

If you have not received Form 1095-B via U.S. mail, you may request another copy from the CMRCC Fund by email, phone, or written request.  The Fund will mail you the form within 30 days of receiving your request. The contact information to submit a request for Form 1095-B is as follows:

·         Email: 1095Bhelp@benesys.com

·         Phone: (800) 700-6756 between 7:00 AM and 4:30 PM EST

·         Mail:

BeneSys, Inc.
700 Tower Drive, Suite 300
Troy, MI 48098-2808
ATTN: 1095-B Requests

You MUST include the following information in your request: (1) Name of the Fund; (2) your name; (3) your name if you are not the primary participant; (4) the address you would like the 1095-B Form sent to; and (5) the phone number we can call if we have any questions.

Please call (800) 700-6756 with any questions about Form 1095-B.

EXPRESS SCRIPTS (Effective October 1, 2024)

GLP-1 MEDICATIONS FOR WEIGHT LOSS

FOR ACTIVES AND PRE-MEDICARE PARTICIPANTS

Effective October 1, 2024, to be able to obtain coverage for a weight loss drug or

GLP-1 medication for weight loss, at a minimum, a covered person must meet all the following requirements at the

time the drug is started:

(a) Be at least 18 years of age.

(b) Have a body mass index (BMI):

(i) Equal or greater than 32; or

(ii) Equal or greater than 27 and have at least two of the following risk factors:

(A) Type 2 diabetes

(B) Hypertension

(C) Dyslipidemia

(D) Obstructive sleep apnea

(E) Cardiovascular or coronary artery disease

(F) Knee osteoarthritis

(G) Asthma

(H) Chronic obstructive pulmonary disease

(I) Non-alcoholic fatty liver disease

(J) Polycystic ovarian syndrome

(c) Submit evidence that the covered person will or has been engaged in behavioral

modification and a reduced-calorie diet

IMPORTANT NOTE FOR THOSE

ALREADY RECEIVING COVERAGE FOR WEIGHT LOSS DRUGS: 

As of October 1, 2024, if you would not have qualified for coverage under the new criteria when you began taking the drug, you will no longer be approved for coverage. Here are two examples of how this will work:

Example 1: On June 1, 2024, Participant A had a BMI of 31 and was approved for weight loss drug coverage. As of October 1, assuming Participant A’s BMI is under 32, Participant A will not be eligible for continued coverage unless Participant A otherwise meets the new criteria.

Example 2: On June 1, 2024, Participant B had a BMI of 33 (baseline BMI) and was approved for weight loss drug coverage. As of October 1, Participant B has a BMI of 31 and, assuming all other coverage requirements are met, will be eligible for continued coverage because Participant B’s baseline BMI meets the new criteria. 

 

(a) Prior authorization is required for coverage to begin and then at least once per year in subsequent years. For each prior authorization after initial approval, have or maintain a 5% weight loss from initial weight.

(b) Enrollment and engagement with Omada, a virtual health program, provided by Express Scripts, the pharmacy benefits manager (PBM). Omada helps members create healthier habits to achieve long-lasting results. To continue coverage of a weight loss medication, you must meet the following requirements each month:

(1) Use the Omada app four times a month, by doing lessons or engaging with your health coach, peer group or online community.

(2) Weigh in four times a month using the smart scale provided by Omada. 

 

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