| ELIGIBILITY FOR BENEFITS |
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| Q. |
Who is eligible to become a
Participant in the Plan? |
| A. |
Any Employee on the payroll for
an Employer who is within the Collective Bargaining Unit covered by the
Collective Bargaining Agreement and on whose behalf contributions are to be
made by the Employer to the Fund. |
|
|
| Q. |
How do I become Eligible under
the Health Care Fund? |
| A. |
Initial Eligibility requires 500
hours contributed within a period of 6 consecuritve months or less. Eligibility starts the 1st day of the 2nd
and 3rd month following. |
|
Example: Work 500 hours during Jan, Feb, March and
Apri, coverage begins June and you
will also remain eligible for July. |
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|
| Q. |
How do I maintain my monthly
Health Care coverage? |
| A. |
Active Participants require 140
contribution hours per month. |
|
|
| Q. |
What happens to hours I work
over the required 140 hours in any given month? |
| A. |
Hours worked over 140 are
deposited into an Hour Bank that can be drawn on for months you do not have
sufficient hours to remain eligible.
You can bank up to a maximum of 840 Hours. |
|
|
|
|
| Q. |
What happens if I do not work at
least 140 hours and I do not have hours in my bank? |
| A. |
You can self pay for any hours
that you are short x the current contribution rate. |
|
Example: You work 100 hours and have no hours in
your bank. You will receive a
self-payment notice to pay for the 40 hours needed for coverage, billed at
the current contribution rate. 40
hours x $7.75 = $310.00 |
|
|
| Q. |
What is SASMI, and can I use the
funds in my SASMI account to make my Self-Payment. |
| A. |
SASMI is an account whereby a
portion of your Employer's contribution is remitted to. You may have a balance with SASMI that you
can use to pay a self-payment to continue coverage. Your SASMI funds can also be used to pay
for your Retiree self-payments. |
|
|
| Q. |
What do I need to do to access
my SASMI benefits to make my self payments? |
|
If you are an Active
Participant, you will receive a self payment
notice from the Benefits office indicating the hours you are short and how
much your self payment is. The
Benefits office will automatically bill SASMI. If you are not SASMI eligible or do not
want to use your SASMI benefits, you will need to mail your payment to the
Benefits office by the due date. |
|
|
|
if you are a Retiree
Participant, and you would like SASMI to make your
Retiree self payments, you will need to contact SASMI directly to set this
up. Once the process is set up, SASMI
will automatically send the amount required for your self payment on a
monthly recurring basis. You do not
need to do anything further. |
|
|
| Q. |
What if I have any questions
about SASMI or want to view my profile with SASMI? |
| A. |
Please contact SASMI Trust Fund
at (703) 739-7250 / website is www.sasmi.org |
|
|
|
Please note: you may access the SASMI link from the
Sheet Metal Workers Local 7, Zone 3 Participant website, as well as view
other information liturature about SASMI. |
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|
| ELIGIBILITY
- DEPENDENT INFORMATION |
|
|
| Q. |
Who are my eligible dependents? |
| A. |
Spouse, natural children,
step-children and adopted children |
|
|
| Q. |
Will my child(ren) who is/are
age 19 through age 26 be covered under the Plan? |
| A. |
Yes, your eligible children are
provided coverage through the end of the month in which they attain age
26. |
|
|
| Q. |
How do I add my new baby or
spouse to my insurance plan? |
| A. |
Contact the Benefits
office. A Personal Information form
will need to be completed (this can be printed from the Participant website),
and will require copies of your marriage certificate, birth certificates. |
|
|
| Q. |
Who should I contact if I'm
getting a divorce and what documents do I need to submit? |
| A. |
Contact the Benefits
office. A copy of your divorce papers
will be needed. You will also need to
complete an updated Personal Information form. (this can be printed from the
Participant website). |
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|
| ELIGIBILITY - ID
CARDS |
|
|
| Q. |
How do I obtain replacement
Medical and Prescription Identification Cards? |
| A. |
ACTIVE Participants -
Medical |
|
Blue Cross: Register on the Blue
Cross website at www.bcbsm.com, and create your own account. You can request your own ID cards for
yourself and your family members. As
an alternative, contact the Benefits office and we can request the ID cards
for you. |
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|
|
ACTIVE Participants -
Prescription |
|
Elixir - Contact the Benefits office for your Prescription ID cards |
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|
|
RETIREE Participants - Medical
and Prescription |
|
Humana - Contact the Benefits office for your Humana Medical and
Prescription ID cards. Member can also contact Humana directly. |
|
|
| Q. |
How do I obtain a replacement
Delta Dental ID cards -ACTIVE AND RETIREES |
| A. |
Delta Dental - Identification
Cards are NOT required. All you need to present to your dental provider
is your name and birthdate and they should be able to log in to Delta Dental
to verify your coverage. However, if
you prefer to have an Identification card for Delta Dental, please log in to
Delta Dental at deltadentalplans.com and order your ID card, or you may contact the Benefits office and
ID cards can be ordered for you. |
|
|
| Q. |
How do I obtain a replacement
EYEMED ID cards -ACTIVE AND RETIREES |
| A. |
EyeMed - Identification Cards
are NOT required. All you need to present to your Eye Care
Practitioner is your name and birthdate and they should be able to log in to
EyeMed to verify your coverage. EyeMed will NOT mail out ID cards.
You are able to download their application to either an I-Phone or
Android. You can access EyeMed's
website at www.eyemed.com. However,
if you prefer to have an Identification card for EyeMed, you may contact the
benefits office and ID cards can be ordered and mailed to you. |
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|
| SHORT
TERM DISABILITY BENEFITS - for Active Participants Only |
|
|
| Q. |
What are the benefits Short Term
Disability - Active Participants Only |
| A. |
Also referred to as Weekly
Disability Benefits. For
NON-Occupational illness or accident, and provided you are eligible at the
time the disability commences, the Plan will provide you with a benefit of
$300 per week, up to a maximum of 26-weeks.
You will be required to provide proof of your disability, by
completing the disability claim form that can be obtained from the Benefits
office, or available to print off the
Participant website. the instructions
for completing the form on the reverse side of the application. |
|
|
| Q. |
What happens to my Eligibility
While Disabled? |
| A. |
Regardless if your disability is
Occupational or Non-Occupational, the plan will credit you with 35 hours of
covered employment for each week you are disabled. (freeze your bank). The maximum number of
weeks you may be credited is 52 weeks. You must provide proof to the Benefits office of your disability. |
|
|
|
Note: if you are applying for a weekly disability
benefit, your application will be used to verify the dates of your disability
to apply your credit hours for eligibility.
For Occupational illness or injury,
you may also complete the weekly disability application for the
application of credit hours, and indicate on the form this is occupational
related. As an alternative copies of
your workers compensation check stubs can be submitted. |