Metropolitan DC Paving Industry Employees Health & Welfare Fund

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Frequently Asked Health Care Questions

Q.	Who is eligible to become a Participant in the Plan?
A.	Active Bargaining and Newly Organized members.
Q.	What if I don’t work enough hours to gain eligibility for the month?
A.	You may make self-payments for up to 6 months or you will receive a COBRA notice.
Q.	How do I maintain my monthly Health Care coverage?
A.	You must work 120 hours each month or 720 hours in prior six consecutive months.
Q.	How do I make a payment towards the continuation of my Health Care coverage?
A.	Contributions must be made monthly to the Fund Office.
Q.	Whom should I call if I have questions about my Health Care eligibility?
A.	You can contact Membership Services at 410-872-9541.
Q.	Who are my eligible dependents?
A.	Spouse, natural children, legally adopted children, participant's legal Step-Children and other children as defined in the SPD.
Q.	Will my child(ren) who is/are age 19 through age 26 be covered under the Plan?
A.	Yes, dependents will continue to be covered until the end of the month in which the child's 26th birthday occurs.
Q.	How do I add my new baby or spouse to my insurance plan?
A.	We will enroll a newborn for 90-days with a birth record while the parents are waiting for the Birth Certificate. To add your spouse please bring a copy of your Marriage Certificate.
Q.	Whom should I contact if I'm getting a divorce and what documents do I need to submit?
A.	Contact Membership Services and submit a copy of the final divorce decree.
Q.	How do I obtain a replacement Medical and Prescription Card?
A.	You can contact Membership Services at 410-872-9541.
Q.	How do I inquire about the status of my medical claim?
A.	You can contact the Claims Department at 410-872-9541.
Q.	Who is the Prescription Drug Benefit Manager?
A.	CVS/Caremark
Q.	How can I contact the Prescription Drug Benefit Manager?
A.	866-282-8503
Q.	If a service I need requires Prior Authorization, who do I (or my provider) contact?
A.	Providers can obtain Pre-Certification by calling American Health Holdings at 800-641-5566.
Q.	If I need to utilize Mental Health or Substance Abuse benefits, who do I contact?
A.	Benefits for Mental Health and Substance Abuse can be obtained by calling 410-872-9541.
Q.	How do I find a dentist or find out if my dentist participates with CIGNA Dental?
A.	CIGNA Dental will be available for this Fund starting October 1, 2019. To find a CIGNA Dentist, contact 1-800-797-3381 or visit cignadentalsa.com
Q.	If I have Medicare, who does my provider submit the claim to?
A.	This Fund DOES NOT coordinate with Medicare.
Q.	Who are my Vision benefits through and how can I contact them?
A.	Vision benefits are paid as member reimbursement. Member can choose to go to any vision providers. Contact the Fund office at 410-872-9541 for breakdown of benefits.