Thursday, December 2, 2021

Frequently Asked Health Care Questions


Q. What is the Plan's prescription service?
A. Envision
Customer Service: 800-361-4542
website: http://www.envisionrx.com
Effective 11/1/09
Participants will pay 30% of the cost of their prescriptions, for both Retail and Mail Order for all generic and brand name drugs.
Q. What is the Plan's rule for initial health care coverage?
A. 375 hours in 6 months (with employer contributions) or less gives eligibility the 1st day of the 2nd and 3rd month following. when participant first becomes eligible 125 hours is added to his bank.
Example: You work 375 hours in from February through July. You will be eligible for health care coverage August 1st and September 1st and you will have 125 hours added to your bank.
Q. What is the Plan's death benefit?
A.
  • Journeyman $40,000
  • Apprentice $40,000
  • Production $30,000
  • Active Self Pay $15,000
Q. What is the Plan's disability benefit?
A. If you become disabled (unemployable because of injury or illness either on or off the job) when you are eligible for benefits, your eligibility will be continued for up to 26 weeks without cost to you. You must file a weekly disability claim form and submit satisfactory evidence of the disability to the Fund Office to be eligible for a non-work related disability. A copy of the Notice of Compensation Payments and copies of your Workers’ Compensation checks are required for a work related disability.
Q. What is the Plan's medical benefit?
A. Blue Cross Community Blue PPO
Customer Service: 800-532-9858
http://www.bcbsm.com
Q. What is the Plan's reinstatement eligibility rule?
A. If you do not make your self-payment by the due date, your coverage will be terminated and you must re-qualify for health care coverage by working 125 hours within 1 month. Provided contributions are received from your employer for these hours, your coverage will be reinstated the first day of the third month following.

Example: Your coverage terminates September 1, for failure to self-pay. You work and contributions are received from your employer for 125 hours in October. Your coverage will reinstate in January.

If you do reinstate within 12 months of your termination date, you must re-qualify for coverage by meeting the initial eligibility requirements described above.
Q. What is the Plan's rule on self payments?
A. If you do not work 125 hours each month, you will be required to make a self payment to remain eligible for health care coverage. The current self pay amount is a flat rate of $400per month. You may continue making self payment based on the number of months that you were previously eligible by hours. For example, if you were eligible for healthcare coverage for five consecutive months by hours, you will be eligible for self pay for five consecutive. This is limited to a six month maximum.
Q. What is the Plan's continuing eligibility rule?
A. Once you have met the initial eligibility requirements, you must work at least 125 hours each month to maintain your health care coverage. There are 2 bookkeeping months between the work month and the eligibility month to give the employer time to report your hours and make the necessary contributions and the Fund Office time to enter this information.
Hours worked in Make you eligible for health care coverage in
January April
February May
April July
May August
June September
July October
August November
September December
October January
November February
December March
Q. How do I add dependents to my Health & Welfare coverage?
A. The following documents will be required to add dependents to your health care coverage. Since many people do not have these documents readily available, you may want to begin accumulating them before you become eligible.

To add a spouse: a copy of a registered marriage certificate and a completed C.O.B Inquiry (included in your enrollment package). To add a natural child: a copy of a state certified birth certificate. To add a stepchild: a copy of the natural parent’s divorce decree and the child’s birth certificate. Additional information may be requested after the divorce decree is reviewed.

Children are covered until the end of the month in which they reach 26 years of age.