Tuesday, June 18, 2024

Frequently Asked Health Care Questions


Q. Who are my eligible dependents?
A.
  • Your lawful spouse
  • Your Domestic Partner (Affidavit of Domestic Partnership required)
  • Your natural children up to age 26
  • Your legally adopted children up to age 26
  • Your step-children up to age 26
  • Your Registered Domestic Partner’s children up to age 26
Q. When do I become eligible for benefits?
A. You become eligible for benefits on the 1st day of the 3rd month following 3 consecutive months in which at least 90 hours per month are reported and paid on your behalf by your employer. A total of 270 hours is required.

Example: If you are hired on April 4th and your work at least 90 hours in April, 90 hours in May and 90 hours in June, your benefits will begin effective September 1st.

Note: There is 1 exception to this initial eligibility rule: 1) Employees of a newly participating employer. For further explanation see page 9 of your Summary Plan Description located under the Documents/Forms section of the website.

Q. How do I maintain my monthly health care coverage?
A. You must work at least 90 hours per month to remain eligible.
Q. Can I accumulate a reserve hour bank?
A.Yes, all contribution hours in excess of 90 hours per month will be credited to your Reserve Accumulation Account for up to a maximum of 90 hours (1 month of coverage). These hours can be used to continue eligibility if your work hours are insufficient for coverage.
Q. When will my eligibility terminate (Loss of Eligibility)?
A. Your eligibility will terminate on the earliest of the following dates:
  1. End of the month in which your Reserve Accumulation Account has insufficient hours to continue eligibility.
  2. Date in which you stop active work for a contributing employer (ex: quit, are discharged or retire)
  3. The date your employer ceases to provide coverage in this plan under a collective bargaining agreement.
  4. Date you enter into full-time military service for over 31 days.
  5. Last day of month for which you made a self-payment.
  6. Date plan is terminated
Q. Can I pay to continue my coverage if it terminates?
A. Yes, if you have at least 60 hours in your reserve bank, you can buy the remaining amount of hours needed for coverage. This payment is deducted from your paycheck by your employer.

If you do not have at least 60 hours in your reserve bank, you can elect to pay COBRA for up to 18 months or 29 months if you are Social Security disabled.

Q. What if I become Disabled and unable to work?
A. The Plan does not provide any disability coverage. You may elect COBRA to continue coverage for yourself and your dependents.
Q. What if I get called to Active Military Duty?
A. You may elect to continue coverage for yourself and your eligible dependents by paying COBRA for up to 24 months. However, no payment will be required if your period of service is less than 31 days.
Q. How do I add my new baby or spouse to my insurance plan?
A. You must submit other legal documentation (ex: Marriage Certificate, Birth Certificate) to the Benefit office along with a completed Enrollment Form. You can download the Enrollment Form off of this website located under "Forms" and mail it into the Benefit Fund Office.
Q. Whom should I contact if I'm getting a divorce and what documents do I need to submit?
A. Please call the Benefit Fund Office and advise the Eligibility and Pension Departments that you are getting a divorce or have already gotten divorced. You will also need to submit a FULL copy of your Dissolution of Marriage Judgment and QDRO (Qualified Domestic Relations Order) to this office.
Q. How do I obtain a replacement Prescription Card?
A. Please send an email to staff@uniteherebenefits.org or contact the Benefit Fund Office at: (619) 849-1060.
Q. How do I obtain a replacement Medical Card?
A. Please send an email to staff@uniteherebenefits.org or contact the Benefit Fund Office at: (619) 849-1060.
Q. Whom should I call if I have questions about my eligibility?
A. Please send an email to staff@uniteherebenefits.org or contact the Benefit Fund Office at: (619) 849-1060.
Q. What if my coverage terminates?
A. If you lose coverage under the Plan as a result of a Qualifying Event, coverage for you and your eligible dependents may be continued for a limited period under COBRA by making monthly payments. Please refer to the Summary Plan Description booklet for more information regarding Qualifying Events.
Q. Will my child(ren) who is/are age 19 through age 26 be covered under the Plan?
A. Yes. Due to the new Health Care Reform Act, dependent children are now eligible to remain on the coverage until the age of 26, regardless of student status.
Q. Whom should I contact for Family Medical Leave (FMLA)?
A. You should contact your employer. If your employer approves a leave under the terms of FMLA, coverage for you and your eligible dependents will continue until the expiration of the FMLA leave or date you give notice to your employer that you do not intend to return to work at the end of the leave.
Q. Does this plan offer Retiree Healthcare coverage?
A. Yes, the following requirements have to be met in order to continue coverage on the retiree plan:
  • Must be age 55 years or older
  • Eligible with the Active or COBRA coverage for 12 of the last 24 months immediately Preceding retirement date; and
  • Approved to receive benefits from the San Diego UNITE-HERE Pension Fund; or
  • Has qualified as an eligible Active member under the Plan for a total of 120 months, and was eligible for health benefits under the Plan for at least one year immediately prior to retirement date.
Q.What is the difference between an Emergency Room and Urgent Care Center?
A. The Differences Between an Emergency Room and an Urgent Care Center

Emergency Rooms Urgent Care Centers
  • Treat severe and life-threatening conditions
  • Hospital emergency rooms have specially trained doctors, paramedics, nurses and other staff that can address a wide variety of medical issues
  • Emergency rooms are open 24 hours a day, seven days a week
  • Focus on diagnosing and treating conditions that are not life-threatening yet they need to be taken care of right away
  • Offer quality care on a walk-in basis
  • Have extended evening and weekend hours
  • Typically provide more complex services than a doctor’s office
Q.What are some common reasons to visit an Urgent Care Center vs. Emergency Room?
A. Some common reasons to visit an Urgent Care Center vs. Emergency Room

Emergency Rooms Urgent Care Centers
  • Chest pain
  • Sudden or severe pain
  • Abdominal pain
  • Difficulty breathing
  • Stroke
  • Severe bleeding
  • A head injury
  • Other major trauma
  • A sprained ankle
  • Ear infections
  • Fever or flu-like symptoms
  • Allergic reactions
  • Minor burns or injuries
  • Coughs, colds, sore throats