Tuesday, February 3, 2026

Frequently Asked Health Care Questions


Q. What documents are required to add a new dependent to my Plan?
A.
  • Spouse - copy of your marriage certificate and spouse’s original birth certificate
  • Domestic Partner - copy of Declaration of Domestic Partnership filed with the State.
  • Child – copy of your child’s original birth certificate (If you are enrolling a newborn, a hospital certificate will be good for 90 days from date of birth and then a copy of the original birth certificate must be submitted.)
  • Step-Child - copy of original birth certificate & proof that you the member support this child. Acceptable documents may include proof of residency from child’s school, Tax return claiming child, divorce documents stating that parent has primary custody of Child and is required to provide healthcare coverage.
  • Adopted Child - copy of legal adoption documents from the court or letter from the state Adoption agency stating the date the child was placed in the home for purpose of legal Adoption. Upon completion of legal adoption, the Plan office will need a copy of the final legal adoptions documents.
Q. Who are my eligible dependents?
A. Your eligible dependents are:
  • Your lawful spouse;
  • Your registered domestic partner;
  • Children until age 26 (includes your natural children, legally adopted children - including children placed with you for legal adoption, your legal ward, stepchildren, foster children and children of your eligible domestic partner);
  • Unmarried children, over age 26, who are totally disabled.
Q. When do I become eligible for benefits?
A. You will become eligible the first day of the second month following the month that you complete a minimum of 440 work hours within a twelve month period.
If you are a Residential member, you will become eligible the first day of the second month following the month that you complete a minimum of 480 work hours within a twelve month period.
Q. What healthcare plans are available?
A. Kaiser (HMO) or Blue Cross (PPO)
Residential employees, service tradesmen, and provisional journeyman service plumbers levels 1-3 will be enrolled in Kaiser (the PPO plan is not available).
Q. How do I add my new baby or spouse to my insurance plan?
A. You must fill out an enrollment form and submit the required documents (ex: marriage certificate, birth certificate). You can download an enrollment form from this website located under “Forms” and mail it to the Trust Fund Office.
Q. What address do I use to send my healthcare payments?
A. Plumbers Union Local 393 - Self Pay
P.O. Box 92149
Las Vegas, NV 
Q. Who should I call if I have questions about my eligibility?
A. The Fund Office's Eligibility Department at (408) 588-3751.
Q. Are there any supplemental unemployment or disability benefits available from the Plan?
A. Yes:
  • Unemployment: $200/week for a maximum of 26 weeks.
  • Paid Family Leave: $150/week for a maximum of 8 weeks per 12-month period
  • Short-Term Disability (State Disability or Workers Compensation): $150/week, or $21.43 for each day of disability less than a full week, for a maximum of 52 weeks.
  • Long-Term Disability (Social Security Disabled): during each year of disability, 12 times the monthly benefit he or she would have received from the Pension Plan had he or she been eligible for a Disability Retirement under that Plan. (Please refer to your Summary Plan Description for eligibility requirements).

    The above benefits do not apply to Individual Employers or non-bargaining employees.
Q. What happens to my ERA after I retire?
A. When you retire, you may draw on your Extended Reserve Account to pay for the monthly premiums for medical and/or dental coverage through the Health and Welfare Plan. You may also use the funds to pay for co-payments, deductibles, and reimbursement of qualified medical expenses which are not covered under the Plan. If you opt out of retiree coverage because you are covered under another group health plan, you and your spouse will still be permitted to use your Extended Reserve Account for reimbursement of qualified medical expenses.
Q. If I die, what happens to the funds in my Extended Reserve Account?
A. In the event of your death, the Extended Reserve Account may be used to provide coverage for your spouse and eligible dependent children. The funds in the Extended Reserve Account may also be used to pay for their co-payments, deductibles, and for reimbursement of their qualified health expenses and to pay for other medical insurance coverage.
Q. Is there a time limit for filing ERA claims?
A. ERA claims must be submitted within one year of the date of service.
Q. What do I have to do to request reimbursement from my ERA?
A. You must complete one ERA form per patient, along with the following information: (NOTE: BALANCE DUE STATEMENTS ARE NOT ACCEPTABLE).
Reimbursement for: Information Required
Medical Co-payments Copy of your Kaiser or U.A. Local 393 Health and Welfare Plan Explanation of Benefits Form (EOB). Balance due statements are not acceptable.
Dental Co-payments Copy of your itemized dental clam/explanation of benefits. Orthodontic services will be paid for after services are rendered.
Vision Co-PaymentsCopy of your itemized vision claim.
Prescription Co-payments Copy of the drug label stub or a printout from your pharmacy. Cash register receipts are not acceptable.
Q. What can I use the Extended Reserve Account (ERA) account for?
A. To pay bills for covered medical, dental, vision or prescription expenses which would otherwise not be payable under the U.A. Local 393 Health and Welfare Plan, (due to co-payments, maximum benefit allowed, or services that are not payable under the plan), or to pay a self payment amount. (Services must be IRS-approved expenses).
The ERA may be used for one or more of the following expenses incurred on or after January 1, 2006:
  • All or part of co-payments required, or amounts in excess of usual, customary and reasonable limits, on covered Medical, Dental or Vision services.
  • Other or denied Medical, Dental, and Vision services.
  • Prescription co-payments.
  • Self Payments
  • Menstrual care products
  • Personal Protective Equipment (PPE)
  • Over the counter medications/drugs
Q. Where do I submit my ERA reimbursement requests?
A.

ERA reimbursement requests can be submitted using one of the methods listed below:

Mail requests to:
U.A. Local 393 Health and Welfare Plan
Attn: ERA Account
PO Box 99416
Troy, Mi 48099

E-mail to: receipts@ualocal393benefits.org

Fax to: 1 (248) 556 - 2597

Q. What happens to my ERA if I work in the plumbing and pipefitting industry for a non-union employer?
A. Even when you are no longer eligible for coverage under this health and welfare plan, you may still draw on your ERA to pay for eligible medical expenses. However, you will permanently forfeit your ERA if you become employed in the plumbing and pipefitting industry for an employer that does not contribute to a health and welfare plan benefiting workers in the pipe trades industry under the terms of a collective bargaining agreement.

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How do I know what medical services the Plan will cover?

Plan benefits and payment structures are described in the Summary Plan Description.  A copy of the SPD can be found on the documents tab on this website. You may contact a Member Service Representative for any specific questions related to your healthcare benefits.  

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How can my provider get an estimate of what the Plan will cover for a specific medical service?

Please have your provider visit the provider portal: memberbenefitsonline.com. The Provider Portal provides Eligibility, Healthcare benefit breakdown and Claims status.  The Provider Portal also has an "ask a question" feature, where one of our Portal representatives will respond back within 24-48 hours.