Saturday, January 24, 2026

Frequently Asked Health Care Questions


Q. What are the Medical Coverage options?
A.This Plan offers a (1) Self-funded Indemnity option (Aetna); (2) WHA HMO option and (3) Kaiser HMO option. For more details regarding these options, you can view the Summary Benefits and Coverage (SBCs) by using the Document tab on this website or you can contact the Trust Fund office using the “Contact Us” tab.
Q. How do I obtain a list of In-Network Providers under the self-funded Indemnity Option (Aetna)?
A.You can click on the Health Care Tab on this website, under Useful Health Care Links, click on the Aetna link and click on “Find a Doctor” located on the top right hand side of the link; or you may go to www.Aetna.com and/or calling 1(800)US-AETNA or 1(800) 872-3862.
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 make a self-payment directly to the Plan, or you may be eligible to continue with COBRA Continuation Coverage. Please contact the Trust Fund Office at (925) 398-7044 or Toll Free at (877) 893-1500.
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 or submit a self-payment (Banquet Workers Only) or elect COBRA Continuation Coverage to continue Health Care Coverage.
Q. How do I make a payment towards the continuation of my Health Care coverage?
A.You may make a self-payment to remain eligible for Health Care coverage through Self-Payment (Banquet Workers Only) or COBRA Continuation. You may mail your check or money order to:

Sacramento Independent Hotel,
Restaurant & Tavern Employees Trust Fund
PO Box 1306
San Ramon, CA 94583
Q. Whom should I call if I have questions about my Health Care eligibility?
A.Please contact the Trust Fund Office at (925) 398-7044 or Toll Free at (877) 893-1500.
Q. Who are my eligible dependents?
A.* Your lawful spouse
* Your registered domestic partner
* Your natural children up to age 26
* Your legally adopted children up to age 26
* Your step-children up to age 26
* Children for whom you've been appointed legal guardian


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 - Copy of your certified marriage certificate
* Domestic Partner - Copy or declaration of domestic partnership filed with the State
* Natural/Step-Child - Copy of your child's certified birth certificate
* Adopted Child - Copy of court order of adoption
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.Please contact the Trust Fund Office at (925) 398-7044 or Toll Free at (877) 893-1500.
Q. How do I inquire about the status of my medical claim?
A.You can log-in to this website with your username and password. After log-in, hover over "Member Benefits" and then click "Healthcare Claims" from the drop down menu.