Tuesday, August 11, 2020

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, which occurs first.

Q.

When do I become initially eligible for benefits?

A.

You will become initially eligible for benefits on the 1st day of the month following the month of which requirements were met. Initial eligibility is met with 750 hours times the fund current hourly rate within no more than 18 consecutive months. When you pass initial eligibility, you will receive 3 months of coverage.

Q.

How do I maintain my continued health care coverage?

A.

Your eligibility will be continued from month to month only if the Fund has received dollars of contributions equal to 80 hours of work in Covered Employment if you elected Participant only coverage; or dollars of contributions equal to 100 hours of work in Covered Employment if you elected Participant plus 1 coverage; or dollars of contributions equal to 110 hours in Covered employment if you elected family coverage, during a Work Month, times the Fund’s hourly contribution rate. There is a two-month delay between the month in which you actually earn coverage by working or by making self contributions and the month in which your coverage is effective. The Fund calls the month in which you earn coverage your “Work Month”, the month in which you are covered for Benefits on the basis of your work or your self-contributions is called your “Benefit Month”. Example of this schedule is for Work Month of January, your will have coverage in the Benefit Month of April; February work is for May 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 30 days of birth, adoption, marriage or other important life changes. Forms Required Are:

  • Spouse – copy of your marriage certificate
  • Child – copy of your child’s birth certificate
  • Step-child – copy of child’s birth certificate
  • 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 Eligibility Department that you are getting a divorce or have already gotten divorced. You will also need to submit a FULL copy of your Divorce Decree to the Benefit Office.

Q.

Whom should I call if I have questions about my eligibility?

A.

Please call the Benefit Office at (717) 564-1561.

Q.

What if I don’t work enough contributions or hour bank credits to gain eligibility for the quarter?

A.

If you fail to have the required employer contributions or hour bank credits to continue healthcare coverage, you may continue coverage by electing COBRA. Each quarter, the Benefit Office will determine if you have enough hours or hour bank credits to continue eligibility. If you do not, you will receive a COBRA package in the mail explaining your rights under COBRA. It is important to read this package thoroughly so that you are aware of your rights and understand the steps for continuing coverage under COBRA.

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. However, if your dependent child is not a full time student, he/she will not be eligible for dental benefits. Dependent children who are not Full Time Students and are between the ages of 19 and 26 will be eligible for medical benfits only. Please contact the Benefit Office at (717) 564-1561 for more information.

Q.

How do I make a payment to continue my Health Care coverage?

A.

You may remit monthly self-payments via personal check, money order or cashier’s check to Union Trowel Trades Benefits Fund of Central Pennsylvania at P.O. Box 97, Troy, MI 48099-0097.

Q.

How to I inquire about the status of my medical claim?

A.

Your medical claims are submitted to CIGNA and then paid by the Fund. Should you have any questions on your medical benefits, claim status, please contact Benefit Office at (717) 564-1561 .

Q.

How do I request a new medical ID or a new non-medical card?

A.

To request a new medical ID card, please contact CIGNA at (800 768-4695) ; for your vision, dental and pharmacy ID card, please contact the Benefit Office at (717) 564-1561.

Q.

How do I add my spouse to my healthcare benefit?

A.

Please contact the Benefit Office at (717) 564-1561 for more information. You may also download a Vital Information Form located on the Health Care page under 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.