Sunday, September 15, 2024

Frequently Asked Health Care Questions


Q.

Who is eligible to become a Participant in the Plan?

A.

You are eligible to participant in the Plan.  If you work for an Employer that is required to make health and welfare contributions to the Plan for work you perform.  For most Participants, this means working in a position covered by a Collective Bargaining Agreement. 

Q.

What if I don’t work enough hours to gain eligibility for the month?

A.

If you fail to have the required employer contribution to continue Health Care coverage, you may be eligible to continue with COBRA Continuation Coverage.  Please contact the rust Fund Office at 844-492-9159.

Q.

How do I maintain my monthly Health Care coverage?

A.

You must have an employer contribution submitted on your behalf each month or elect COBRA Continuation Coverage.  Please contact the Trust Fund Office at 844-492-9159.

Q.

How do I make a payment towards the continuation of my Health Care coverage?

A.

You may make a payment to remain eligible for Health Care coverage through COBRA Continuation Coverage.  Please contact the Trust Fund Office at 844-492-9159.

Q.

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

A.

Please contact the Trust Fund Office at (844) 492-9159.

Q.

Who are my eligible dependents?

A.

Your lawful spouse; Your Registered Domestic Partner; Your natural children up to age 26; Your step-children up to age 26. 

Q.

Will my child(ren) who is/are age 19 through age 26 be covered under the Plan?

A.

Yes.  Due to the Healthcare Reform Act, dependent children are now eligible to remain covered until age 26, regardless of student status. 

Q.

How do I add my new baby or spouse to my insurance plan?

A.

You must submit legal documentation to the Trust Fund 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 Trust Fund Office.  Forms required are:  Spouse: copy of the marriage certificate; Child: copy of birth certificate; Step-child: copy of the original birth certificate along with proof of residency; Domestic Partner: copy of the State of California of Domestic Partnership.

Q.

Whom should I contact if I'm getting a divorce and what documents do I need to submit?

A.

Please contact the Trust Fund Office at (844) 492-9159.

Q.

How do I obtain a replacement Medical and Prescription Card?

A.

Please contact the Trust Fund Office at (844) 492-9159.

Q.

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

A.

Please contact the Trust Fund Office at (844) 492-9159.

Q.

Who is the Prescription Drug Benefit Manager?

A.

Kaiser

Q.

How can I contact the Prescription Drug Benefit Manager?

A.

www.kp.org or (800) 464-4000

Q.

If a service I need requires Prior Authorization, who do I (or my provider) contact?

A.

All medical benefits are provided through Kaiser directly, including authorizations.

Q.

If I need to utilize Mental Health or Substance Abuse benefits, who do I contact?

A.

All medical benefits are provided through Kaiser directly, including authorizations.

Q.

How do I find a dentist or find out if my dentist participates with Delta Dental?

A.

Contact Delta Dental directly at (888) 335-8227 or via www.deltadentalins.com.

Q.

If I have Medicare, who does my provider submit the claim to?

A.

There is no Retiree coverage.

Q.

Who are my Vision benefits through and how can I contact them?

A.

VSP (800) 877-7195 or www.vsp.com

Q.

Eligibility, how do I become eligible for Durable Medical Equipment?  

A.

You must be eligible for Health and Welfare Benefits in the month in which you are purchasing Durable Medical Equipment.  Participants needing Durable Medical Equipment that has been prescribed by a Kaiser physician will need to purchase the equipment and submit the receipts to the Trust Fund office for reimbursement.  Please contact the Trust Fund office at (844) 492-9159.

Q.

 Are there any Death Benefits Available?  How do I qualify for Death Benefits?

A.

Yes.  You must be actively at work on a full-time basis and be eligible for and receiving benefits from the Plan at the time of your death or dismemberment to be eligible for such benefits.  

Q.

Is there a filing limit for Death Benefits?

A.

Claims for Death, Accidental Death or dismemberment benefits must be filed with the Fund Administration office within One (1) Year from the date of the death or dismemberment, you or your beneficiaries should contact the Trust Fund office at (844) 492-9159.

Q.

Who is Eligible for the Death Benefit? 

A.

A Participant who is an employee performing worked covered by the Collective Bargaining agreement and be actively at work - means you are performing the regular duties of employment on the day either at the Employer's place of business or at some location to which the Employee is required to travel for the Employer's business.  Actively at work includes each day of a regular paid vacation and each regular non-workday if the Employee was Actively at Work on the last preceding regular workday but does not include time off as a result of insure or illness. 

Q.

How Much Does the Benefit Pay?

A.

Death Benefit of $12,500 paid to your beneficiary in the event of your natural death.  Accidental Death or Dismemberment benefit is $12,500 benefit paid to your beneficiary in the event of your accidental death.   A $6,250 benefit will be paid for the loss of one hand, one foot or the sight of one eye. 

Q.

How are benefits paid out, who receives the benefits when I pass?  

A.

Please contact the Trust Fund Office at (844) 492-9159.