Friday, July 19, 2024

Your Health Care Benefits



Your Health Care Benefits

The Board of Trustees is pleased to welcome you to the new Health Care website for the San Diego UNITE HERE Health and Welfare Plan. Within this website, you will now have access 24 hours a day, 7 days a week to commonly requested forms, useful highlighted links, and frequently asked questions regarding your benefit information. As always, please feel free to contact the Benefit Fund Office at (619) 849-1060 if you have any additional questions or concerns.

The San Diego UNITE HERE Health Fund was established in accordance with Collective Bargaining Agreements between the Local 30 UNITE HERE and participating Employers. Some of the benefits available to you are fully insured and provided through a contract with a carrier. Other benefits are self-funded and provided directly by the assets of the Fund.

Eligibility for Benefits

Your Employer will report your work to the Plan in one of two ways: either on an hourly basis or by paying a flat rate. When your Employer reports on an hourly basis, you become eligible for coverage on the first day of the third month following three consecutive months in which 270 hours have been reported and paid to the Fund. When your Employer contributes a flat rate, your initial eligibility will depend on the terms of the Collective Bargaining Agreement under which you work. Please contact the Trust Fund Office for more information about your initial eligibility date.

To maintain eligibility each month under the hourly basis, you must work at least ninety (90) hours per month. If you work more than 90 hours, the excess will be credited to your hour bank reserve, up to a maximum of 90 hours.

If you have coverage on a flat-rate basis, you will continue to be eligible as long as your Employer makes the flat-rate contribution to the Fund.

Medical Plan Options

Kaiser Permanente (HMO): You will obtain all services through Kaiser Hospitals, Kaiser urgent care centers or other Kaiser facilities. Prescriptions are also obtained from Kaiser Pharmacies. Employees hired on or after April 1, 2013, are not eligible to enroll in Kaiser for the first two years of eligibility. The monthly self-payment when enrolled in Kaiser is $50.

Self-Funded PPO Plans: Blue Cross will provide the PPO network for claims incurred after September 1, 2013. There are three “Blue Plans”: Blue Basic, Blue Select and Blue Plus. Blue Basic coverage covers you (the Participant) only and does not require a monthly self-payment. The Blue Select coverage covers you and your family, and requires a monthly self-payment of $20. The Blue Plus coverage covers you and your family, and requires a monthly self-payment of $80.

SIMNSA (HMO): The SIMNSA HMO coverage covers both you and your family, does not require a monthly self-payment, and requires you to receive all your care from SIMNSA providers.

Dental Plan Options

The San Diego UNITE HERE Health Fund offers dental coverage. Unless you are enrolled in the Blue Basic Plan described above, you are automatically covered for dental benefits. You have a choice of two dental plans: The Self-Funded Dental Plan and the SIMNSA Dental Plan.

Please note that effective November 1, 2013, you must be enrolled in the SIMNSA Medical Plan to enroll in the SIMNSA Dental Plan. Retirees must select and pay for dental coverage.

Vision Plan

Participants are eligible for vision care unless you are enrolled in the Blue Basic Plan. Your benefits are provided through Vision Service Plan (“VSP”). Retired Participant are not eligible for vision benefits.