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Frequently Asked Questions


Active Members:

Medicare and non-Medicare Retirees

Medicare Eligible Participants

Health Claim Questions

Health Reimbursement Account Questions



ACTIVE MEMBERS

I am a new employee. When will I be eligible?

You are initially eligible for benefits on the first day of the month following the completion of four months of continuous employment with an Employer, provided you have a least 400 credited hours of employment in that four month period, with a least one hour in each of the four months. See page 12 of the Summary Plan Description.

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How do I know when I need to make a self-payment?

If you lack the required hours to continue eligibility, the fund office will notify you by sending a self-payment notice to the address on file. It is still your responsibility, however, to keep track of your hours and make sure that your eligibility has not terminated.

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What do I do when my employer has not reported my hours worked to the Fund?

You will need to send the Fund a copy of your check stubs. Your check stubs should include your name, hours worked, date and the employer name.

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What do I do when I work outside my home local?

You need to contact the Fund office for a transfer authorization, or you may print an authorization by going to Formsand print off the form and send to the Fund office.

Please note: If you are working on a pipeline job and your contributions are paid to the Pipeline Health & Welfare Fund you will need to complete their transfer authorization. You may contact the Pipeline office at 888-255-3863.

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I am thinking of retiring. What is the cost of retiree health coverage, after I retiree?

The self-payment program for Retirees is based on a point system and an individual class. The employee point total is based on the Employee’s age and total credited service under the plan at retirement. For example, if you are age 65 and have 35 years of Credit Service on your retirement date, your point total is 100 (65+35). You and your spouse/dependent class are based on each individual age. Class 1 age 64 and under; Class 2 age 65 and older or have Medicare. For current rates effective 4/1/2015 you may click on the Retire Rates: Self-Payment Rates for Retirees On or After December 1, 2007. Remember these are monthly, individual rates, depending on your Class, Age and Points.

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What are my deductibles, out of pocket costs, co-pays, prescription co-pays, etc?

Please view the Schedule of Benefits for your Plan in the Summary Plan Description/Plan Document:

Coordination of Benefits See page 65 of the Summary Plan Description.

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I have had a change in Family Status due to marriage, divorce, having a baby, adopting a child, and or dependent child, etc.?

Please view page 29 of the Summary Plan Description/Plan Document: under “Notify the Welfare Fund.”

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I need a copy of my divorce decree, birth certificate, death certificate or other records.

Information on how to obtain these items can be found at:
Vital Records:
Indiana: www.in.gov/isdh/index.htm
Illinois: www.idph.state.il.us/vitalrecords

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MEDICARE ELIGIBLE PARTICIPANTS

I just received my Medicare Card, should I notify the Fund office?

Please send a copy of your Medicare Card to Mid Central Operating Engineers Health and Welfare Fund, P. O. Box 9605, Terre Haute, IN 47808, as soon as possible.

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I just received Social Security Disability, should I notify the Fund office?

Please send a copy of your Social Security Disability Award Letter to Mid Central Operating Engineers Health and Welfare Fund, P. O. Box 9605, Terre Haute, IN 47808, as soon as possible. If you received Medicare along with your disability, also provide a copy of the Medicare card.

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My health claims are not being sent to Mid Central Operating Engineers Health and Welfare Fund, by Medicare. This is called Medicare crossover.

Did you send us a copy of your Medicare card, if not, please do so immediately. Also, please check with your providers of health services, as they might be filing your claims with the Medicare Secondary Unit. Please make sure they have you coded as Medicare primary. Please verify that you have the proper insurance card. As Medicare primary you should have a Mid Central Operating Engineers Health and Welfare Eligibility Card.

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Do I have to sign up for Part B coverage, if I am still working and not retired?

You will need to sign up for Part B coverage, when you actually stop working or retire. If you do not sign up for Part B coverage, the Fund will still coordinate with Medicare, as if you had Part B. This means if Medicare does not allow any charges, neither will the Fund, and you will be responsible for the total charge.

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I did not sign up for Part B when I retired, what should I do?

Medicare has their open enrollment period from January 1st through March 31st, of each year. You might be penalized and your Part B coverage might be delayed. Please go to your local Social Security office, and they will be able to give you the needed information, for your particular situation.

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I signed up for Part D prescription coverage and I now want to have prescription coverage through Mid Central Operating Engineers, what should I do?

Mid Central Operating Engineers has an open enrollment period from October 15th through December 7th of each year. Reinstatement of prescription drug benefits in the Mid Central Operating Engineers Health and Welfare Fund is allowed once in your Lifetime.

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My health claims are still being filed with Anthem since Medicare became primary.

Did you inform all of your providers of health services that Medicare is now primary on you? Did you show them you’re correct Identification Card that states Retired Member? If you do not have the correct Identification Card, please contact the Fund and we will issue you a new card.

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My provider of health services does not accept Medicare assignment. What does this mean?

This means that you will be responsible for the difference in the charge and Medicare allowed amount. Example: Charge is $40.00 and Medicare allowed $24.00 and paid 80%. You will be responsible for the $16.00 in full. The Fund will allow benefits on the $24.00 which would be the 20% that Medicare did not pay.

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HEALTH CLAIMS QUESTIONS

How often do I need to complete a claim form?

The Fund will request a claim form for:

  1. The first claim of each year; and
  2. Whenever there is an accident indicated; and
  3. Updates through out the year.

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How do I obtain new medical cards or prescription cards?

BCBS / Anthem cards can be provided by the Fund office. Caremark/CVS cards may be obtained by contacting Mid Central Operating Engineers 1-877-299-3699 or Caremark/CVS customer service,1-888-796-8675

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What is the time limit to file claims?

The Fund has a 12 month filing limit from the date of the initial service. except on Medicare claims, which is 18 months from the date of the initial service. See page 39-40 of the Summary Plan Description.

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My claim was denied, how do I file an appeal.

Please refer to page 42 of the Summary Plan Description,“Appealing a Denied Claim”.

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Can my step-children be eligible for health benefits?

Yes, you can cover step-child in the Plan, but there are certain requirements and needed information before the Fund can approve eligibility. Please refer to page 13 and 14 of the Summary Plan Description, “Enrolling Dependents for Coverage.

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MEDICARE AND NON-MEDICARE RETIREES

Can I add a dependent to my coverage once I retire?

Yes, you may add your new eligible dependents to the Plan by providing the administrator with a properly completed application form, subject to administrative approval. This application form requesting special enrollment must be provided to the administrator within 30 days of the date of the qualifying event (i.e., the marriage, birth, adoption or placement for adoption). If you do not enroll your spouse and dependent children within the 30 day period, you will not be provided another enrollment opportunity. In the event your spouse and dependent are enrolled in an employer sponsored plan, contact the Fund office to inquire about the Opt-out program.

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Can I postpone/suspend coverage under the retiree program and still be eligible at a later date?

Yes, you and your Dependents are given an opportunity to postpone or suspend coverage and remain eligible for later coverage once; this may be when you initially retire or later. Please refer to page 26 - 27 of the Summary Plan Description, for full details of the Retiree In-and-Out Program.

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HEALTH REIMBURSEMENT ACCOUNT QUESTIONS

What is the hourly contribution rate credited to health reimbursement account?

The HRA will be funded at an hourly rate determined by each Local. Please contact the Fund office for hourly contribution rate.

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Do I have to be eligible for benefits to request expenses for reimbursement?

Yes, you must have been eligible at the time services were provided.

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Who is eligible to file a claim under the health reimbursement account?

You are eligible for reimbursement of covered expenses incurred by you and your eligible Dependents.

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What happens to the HRA balance once I am no longer eligible?

Once you are no longer eligible for coverage, you may continue to submit eligible expenses for reimbursement from your HRA for expenses you incurred before your coverage ended. However, any expenses incurred after your coverage ended are not eligible for reimbursement.
Once you are no longer eligible for coverage, the Plan will maintain your HRA (without any additional contributions or reimbursements) for up to 24 months (six consecutive eligibility periods). Any unused credit in your HRA will be forfeited after this 24-month period during which you are not eligible for coverage. This means that if you have not been covered under the Plan for 24 months or more, your HRA balance will be forfeited and cannot be reinstated. Please refer to page 59 of the Summary Plan Description, for full details on Termination of Coverage.

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What is the dollar amount that can be submitted for reimbursement?

The Plan requires that requests for reimbursement be for a minimum of $200.00. However, you may submit a request for reimbursement for claims totaling less than $200 once per year each February if your total claims for the prior year are not going to reach the $200 minimum. Please refer to page 61 of the Summary Plan Description, Reimbursement Procedures for full details.

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Do HRA funds roll over each year?

Yes, if money remains in your HRA at the end of the year, it rolls over into the next year.

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What paper work is required to submit for reimbursement?

To receive reimbursement for eligible expenses, you must submit a completed HRA claim form. Along with the form, you must provide any of the following, as applicable:
*Reimbursement on deductible and/or coins, forward a copy of our Explanation of benefits.
*Reimbursement on dental and vision, please forward an itemized bill from the service provider that includes the name of the person incurring the charges, date of service, description of services, name of provider, and amount of charge.
*An Explanation of Benefits (EOB) from any other coverage when requesting reimbursement of the balance of charges for which other coverage is available.
*A receipt and proof of purchase or rental for covered items (such as for crutches or wheelchairs).
*Any additional documentation requested by the Plan.
Please refer to page 61 of the Summary Plan Description, Reimbursement Procedures for full details.

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What expenses are eligible for reimbursement under the HRA?

An eligible medical expense is defined as an expense paid for care as described in Section 213(d) of the Internal Revenue Code.

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Can I use funds in my HRA account towards my active/retiree self-payment?

Yes, provided that all necessary paperwork is received by the Fund by the self-payment due date.

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