Thursday, December 2, 2021

Frequently Asked Health Care Questions


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
  • Child for whom you have been appointed legal guardian by court for length of guardianship or to age 26, whichever occurs first
Q.When do I become initially eligible for benefits?
A. Employer contributions will be credited towards your dollar bank account.  You will become eligible for benefits on the first day of the second calendar month after your dollar bank account has at least $975. For example, you will become eligible March 1 if you are hired in October, work during the three month period of October through December, and have contributions of at least $975 ($950+ $25 subsidy) made on your behalf by the end of January.
Q.How do I maintain my monthly health care coverage?
A.You must have $950 employer contributions or in your dollar bank each month to continue healthcare coverage.
Q.How do I add my new baby or spouse to my insurance plan?
A.

You must submit other legal documentation to the Benefit office along with a completed Vital Information Form.  You can download the Vital Information Form off of this website located under "Forms" and mail it into the Benefit Office.  You must enroll your new dependent within 60 days of birth, adoption, marriage or other important changes.

 Documentation Required:

  • Spouse - copy of your marriage certificate
  • Child - copy of your child's birth certificate
  • Step-child - copy of child's birth certificate, copy of taxes, divorce decree or copy of existing court order showing spouse must provide medical benefits
  • Adopted child - copy of legal decree of adoption
  • Child for whom you have been appointed their legal guardian - original copy of legal guardianship documents (if temporary guardianship, status updates will be required every 6 months). 
Q.Whom should I contact if I'm getting a divorce and what documents do I need to submit?
A. Please call the Benefit Office and advise the Eligibiity Department that you are getting a divorce or have gotten divorced. You will also need to submit a FULL copy of your Divorce Decree to the Benefit Office.
Q.How do I obtain a replacement Prescription Card?
A. If you are an Active or Early Retiree, please contact Express Scripts at (800)716-2932.

If you are a Cleveland or Southwest Medicare Retiree, please contact Express Scripts/EGWP at (800)311-2757.

If you are a Niles Medicare Retiree and are enrolled in the Express Scripts PDP plan, please contact Express Scripts at (800)378-4879. 

Q.How do I obtain a replacement Medical Card?
A.Please contact the Benefit Office at (855)837-3528 or (248)641-4967.
Q.How do I obtain a replacement Dental Card?
A.If you are an Active or Non-Medicare Retiree, your dental coverage is provided by Delta Dental. You do not need a dental ID card. When you need to visit the dentist, let them know that you have coverage through Delta Dental and give them your Social Security Number. Your dentist office should then be able to obtain all of your information by contacting Delta Dental at (800)524-0149.
Q.What if I don't work enough contributions or dollar bank credits to gain eligibility for the month?
A.If you fail to have required employer contributions or dollar bank credits to continue healthcare coverage, you will be permitted to remit monthly self payments equal to the amount required to continue coverage. Please contact the Benefit Office at (855)837-3528 or (248)641-4967 for more information.
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 on the coverage until the age of 26, regardless of student status.

Please contact the Benefit Office at (855)837-3528 or (248)641-4967 for more information. 

Q.How do I make a payment to continue my Health Care coverage?
A.You may remit month self payments via personal check, money order or cashier's check to Ohio Carpenters Healthcare Plan, P.O. Box 74192, Cleveland, OH 44194-02650.
Q.How do I inquire about the status of my medical claim?
A.Your medical claims are paid by Benesys. Please contact the Benefit Office at (855)837-3528 or (248)641-4967 for any questions regarding medical benefits and claims.
Q.How do I inquire about the status of my healthcare eligibility?
A.Please contact the Benefit Office at (855)837-3528 or (248)641-4967 for information about your healthcare eligibility.
Q.How do I add my newborn child to my healthcare benefit?
A.Please contact the Benefit Office at (855)837-3528 or (248)641-4967 for more information. You may also download a Vital Information form located on the Health Care page under the Health Care Forms section of this website. Once downloaded, complete the vital information form in its entirety and submit a copy of your newborn child's birth certificate within 60 days.
Q.How do I add my spouse to my healthcare benefit?
A.Please contact the Benefit Office at (855)837-3528 or (248)641-4967 for more information. You may also download a Vital Information form located on the Health Care page under the Health Care Forms section of this website. Once downloaded, complete the vital information form in its entirety and submit a copy of your marriage certificate.
Q.I am a Working Retiree. How are my employer contributions used for my healthcare coverage?
A.As a Working Retiree, any healthcare contributions received on your behalf will be deposited into your Health Reimbursement Account (HRA) after a $200.00 subsidy plan fee has been applied. For example, if $300 in employer contributions are received on your behalf for healthcare coverage, $100.00 will be deposited into your HRA account. You can use your HRA account for qualified medical reimbursement expenses as well as Retiree health coverage self payments.
Q.Do I have to use mail order for my prescriptions?
A.Maintenance medications (medications you take long term) require mail order. After your 3rd fill at a retail pharmacy, you will pay the entire cost if you continue to purchase it at the pharmacy.