Insurance

QUESTIONS	ANSWERS
When do I become eligible for benefits?	All Clerks hired after March 1, 2004 become eligible in their 13^th month of employment. Clerks Helpers become eligible in their 19^th month of employment.
What family members are covered?	Spouse, unmarried children and stepchildren under 19 years of age, some foster children, and legally adopted children. Unmarried children 19 through 24 years of age who are full time students with Student Certification on file. And unmarried children regardless of age who are unable to support themselves because of mental or physical handicaps. Clerks helpers hired after March 1, 2004 under Plan A-110 do not have dependent coverage. Clerks have dependent coverage after 30 months of employment. For Plan B-110 (hired after 10-3-04) utility clerks have no dependent coverage. All other clerks have dependent coverage after 30 months of employment.
How many hours a month do I have to work for benefits?	What is a month? The hours you work in any one week are credited to you as of each Sunday, based on the standard Industry workweek, which is Monday through Sunday. Your monthly hours are credited to you as of the last Sunday of each month. 64 hours: All Clerks Helpers and Utility Clerks 76 hours: Plan B, Plan B-110: Food & GM Clerks, Plan G 92 hours: Plan A, A-1, A-110: Food & GM Clerks
When can I switch coverage?	During open enrollment each January. You can change once in a 5 year period outside open enrollment. (Except Plans A-110, B-110)
What pre-paid plans are available?	Kaiser, PacifiCare (Not available to A-110 and B-110 members)
When will I qualify for pre-paid?	Plan A-1: After 24 months of earned eligibility. Plan B Utility Clerks: After working through two Open Enrollments. OR If promoted, after two months of hours in your new position. Plan B All Other Job Classifications: Have choice of pre-paid from beginning of eligibility. Plan G: Beginning of eligibility. Plan A-110 & Plan B-110: not available.
If a claim is denied, how do I appeal the claim?	Request an appeal form from the Insurance Dept. And follow the directions on the form.
Clarify student coverage.	Students are covered from age 19 through their 24th birthday month as long as they are unmarried and attending an accredited school full time. A completed “Student Certification”, signed by the member and School Registrar, must be on file each quarter or semester. To cover the summer months the member must complete and sign a “Student Certification of Intent to Return to School After Summer Recess” each year.
I have to have surgery, what should I do?	Under Indemnity: Use a contracting hospital and have doctor call the Review at 1-800-274-7767 before you go in. Under Pre-paid: See Plan provider.
I have not received medical card yet, why?	Indemnity Plan members receive a Medical Plan 2000+ card and use providers from a list. It takes the plans almost a month after you become eligible to send out cards. If you need help you may call their 800#. Blue Cross Group 57D72A 1-800-825-1030 Pacificare Group 737 1-800-624-8822 Kaiser Group 1500 1-800-464-4000
Explanation of billings received when members are short hours for medical coverage	The COBRA notice is very important for those members who have lost eligibility and wish to continue benefits. They should complete the form and mail it back as soon as possible with a payment. If you were on: 1) approved family leave; 2) paid vacation; or 3) state disability or worker’s compensation, complete the applicable part of the form and return immediately. If on state disability or worker’s compensation, submit proof of payment from the state or the insurance carrier. If you did work sufficient hours, copies of your check stubs should be submitted. Please read the form carefully!
How long will my benefits last after I quit?	If you were on: 1) approved family leave; 2) paid vacation; or 3) state disability or worker’s compensation, complete the applicable part of the form and return immediately. If on state disability or worker’s compensation, submit proof of payment from the state or the insurance carrier. If you did work sufficient hours, copies of your check stubs should be submitted. Please read the form carefully!
Disclaimer: This information has been written as clearly and accurately as possible. You should be aware, however, that benefits are governed by master policies, contracts and Plan documents. In all cases of benefit determination or differences of opinion, the legal policies, contracts or Plan documents will prevail. You can examine the master policies, contracts and Plan documents by contacting the Fund Office. If you prefer, you can request, in writing, copies of these documents for a reasonable fee. The Fund Office will send you the documents within 30 days of receiving your request. The Fund maintains the Health Care Plan for the exclusive benefit of eligible employees; however, eligibility for or participation in the Health Care Plan is not an assurance or guarantee of continued employment.

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