Wednesday, May 12, 2021

Frequently Asked Health Care Questions


Q. When do I meet initial eligibility for coverage under the Health and Welfare Plan?
A.

You will meet the initial eligibility requirements on the first day of the month following any two consecutive calendar quarters (six consecutive months) in which you work in both quarters and your employer made contributions to the Fund on your behalf for at least 440 hours. The eligibility dates each year are January 01, April 01, July 01 and October 01 as shown in the table below:

Work Months Eligibility Months
January thru June July thru December
April thru September October thru March
July thru December January thru June
October thru March April thru September
Q. What are the requirements for continuing eligibility?
A. You will continue to be eligible for benefits during any two consecutive calendar quarters that immediately follow two consecutive quarters in which you work in both quarters and your employer makes contributions to the Fund for at least 440 hours or non-work credit hours are granted due to an approved disability.
Q. Who is primary if my spouse has coverage through their employer?
A.

Your coverage will always be primary for you and your spouse’s coverage will always be primary for your spouse. If you have coverage for your dependent children, the primary payer will depend on when you and your spouse’s birthday fall in the year. If your birthday falls earlier in the year than your spouse, your plan will be the primary payer. If you spouse’s birthday falls earlier, then their plan becomes primary. This is considered the “birthday rule”.

If you are a member of Local 321 or 577, it is mandatory that your spouse accept coverage through his/her employer if available. 

Q.Who is my prescription drug coverage through?                       
A.The prescription drug coverage is through CastiaRx.                                     
Q.Does CastiaRx offer mail order?                                               
A.Yes. Mail order is an option under the Plan.
Q. Is vision coverage included in the Plan?
A. Yes, for eligible Active employees and qualified dependents in Locals 46, 321, 392, 396, 577, and 782. The vision program is administered by Vision Service Plan (VSP). Under this program, Active employees and their dependents can get a comprehensive eye exam every 12 months from an in-network VSP doctor for a $10 co-payment. Frames are covered up to $115 allowance, plus 20% off the amount over your allowance Vision expenses and lenses at covered at 100%. You should review the Summary Plan Description for out-of-network benefits.
Q. Is dental coverage included in the Plan?
A. Yes, for eligible Active employees and qualified dependents in Locals 46, 392, 396, 577, and 782. Covered Dental expenses are subject to a $25.00 annual deductible per individual or a $75.00 annual family deductible. The annual maximum per individual is $2,000.00. You should review the Summary Plan Description for a summary of benefits.
Q. Is there any way to continue coverage once it’s terminated?
A. Yes. If you or your dependent should lose coverage as a result of a Qualifying Event, coverage may be continued for a limited period of time under COBRA by making a timely election and making monthly payments to the Fund. You should review the Summary Plan Description to understand the Plan requirements and your rights under COBRA.
Q. What happens if I don’t have enough hours for contributions?
A. Your eligibility will end on the last day of the last two consecutive calendar quarters for which you did not meet the requirements for continuing eligibility in both quarters and 440 hours of contributions paid. Coverage termination dates are March 31, June 30, September 30 or December 31.
Q. What do I do if I enroll my spouse and then become divorced?
A. You must provide a copy of the divorce decree. Coverage for your spouse will be terminated as of the date of the divorce stated in the decree.
Q. Do I have to provide proof of dependent status?
A. Yes. You must provide a copy of your marriage license if you are enrolling your spouse, and a copy of the birth certificate for any dependent children you are enrolling.
Q. How does future eligibility work?
A. You will remain eligible for at least six months. Your eligibility will continue for the succeeding six month intervals as long as the required contributions are made on your behalf.
Q. Are my dependents eligible for coverage?
A. Your spouse is eligible as long as you are married and not separated under a judicial decree. Your children are eligible up to age 26.                                           
Q. Are the eligibility requirements the same for Owner-Operators?
A. No. Owner-Operators contributing on their own behalf must have at least 425 hours in the same periods noted above.