Frequently Asked Questions
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- When will I first become eligible for benefits?
Bargaining Unit Employees
All Employees working for a contributing Employer pursuant to a Collective Bargaining Agreement with Local 4,
166, 678, 308, and 1260 of the Industrial Brotherhood of Carpenters (Local Union Contract) shall be eligible to
receive benefits after meeting the following eligibility requirements.
1. Initial Eligibility for Participants Working Under a Collective Bargaining Agreement
Once a Participant has accumulated $3,100 in the sum of the DB and the HRA accounts within 12 consecutive
months in covered employment under a Local Union Contract to which contributing employers are signatory, the
Participant will gain initial eligibility into the Health & Welfare plan. Benefit coverage will begin the first
of the month following the month the $3,100 of contribution was RECEIVED at the Fund Office. The following is
||The Following Month B
||The Following Month C
|You meet your $3,100 dollar eligibility requirement...
||The Contractor reports your contributions worked for prior Month A to THIRD-PARTY ADMINISTRATOR
||The Third-Party Administrator then sends Notice of eligibility beginning the FIRST OF THE MONTH C
So, for example, if you reached $3,100 in January, your coverage begins March 1st.
The Employee’s eligibility after the first quarter of eligibility will be determined under the provisions
for Continuation of Eligibility. For initial eligibility, the Participant's accumulated DB and HRA accounts
in the initial eligibility quarter will be charged at the rate of $1034 per month for the number of months
remaining in the initial quarter in which the Participant attained eligibility. For example, the Participant
who attained their $3,100th work contribution in January would be eligible for benefits March 1st. March is
the third month of the first coverage quarter (see coverage quarters following). Since only one month (March)
remains in the coverage month quarter, the Participant's accumulated DB and HRA accounts would be deducted on
the 1st of March in the amount of $1034.
- How do I continue my eligibility?
- Once a Participant becomes eligible, he/she will continue to be covered under the Plan of Benefits for a
coverage quarter. Eligibility will continue for subsequent coverage quarters, unless there is a terminating
event, as long as the Participant has $3,100 of contribution credit in his/her accumulated DB and HRA accounts at
the beginning of such period. A Coverage Quarter is defined according to the following schedule:
|Work Performed During
||Determines Eligibility For
|September, October, November
||January, February, March
|December, January, February
||April, May, June
|March, April, May
||July, August, September
|June, July, August
||October, November, December
- How do my DB and HRA Accounts work?
- All contributions made on a member’s behalf while working for a participating employer are made to the DB
account. Once the DB account reaches the current required level of $150.00, all contributions made for the member
on or after January 1, 2012, are transferred to their HRA. Note: no contributions can be transferred from a
member’s HRA to their personal DB account. Also, your accounts can never be negative. There is no maximum on your
Eligibility reports will be sent to each member each quarter to inform them of the number of hours contributed
on their behalf by the employer in the preceding twelve months. Should you notice any discrepancy in the
reported hours, contact the fund office. This report also provides you with a summary of the activity for your
DB and HRA accounts for the last quarter.
If you have lost your eligibility, and wish to self pay, you have until the last business day of the month
preceding the beginning of the eligibility quarter for which you are making payment. Loss of eligibility will
cause your accounts to be reduced to zero.
Your HRA account will be charged during each calendar year for all eligible reimbursements. The amount
available for reimbursement for Allowable Medical Care Expenses is the balance available in your HRA, which are
the contributions credited to your Individual Account less any reimbursements paid.
- PARTICIPANT’S CONTRIBUTIONS
- Contributions for hours worked will not be added to a Participant's DB account until the cash contribution for
the hours worked is actually received by the Fund Office and added to the Participant's DB account for purposes
of determining eligibility for Fund Benefits.
- Continuation of Eligibility without Employer Contributions
- Participants will continue to be covered by the Plan of Benefits so long as a Participant has dollars
accumulated in their DB and HRA accounts sufficient to continue their coverage. Participant's coverage shall be
terminated at the end of the coverage quarter when the Participant's account is reduced to zero. Participant's
accounts will be reduced to zero when:
- The Participant stops working for contributing employers when such work is otherwise available; or,
- A Participant is promoted by an employer to an employment category not covered by the Collective Bargaining
Agreement in effect between the employer and the union at the time of such promotion; or,
- Participant's accounts are less than $3,100 at the beginning of an eligibility quarter, due to unemployment
and Participant does not make up the difference in self-contribution for the quarter.
- A Participant goes to work for an Employer in the Carpentry industry who is not signatory to a Collective
Bargaining Agreement with a Local Carpenters Union.
- What is Self-Payment of Contributions?
- After a Participant becomes initially eligible, and the Participant has insufficient hours in his/her
accumulated DB and HRA accounts at the beginning of a coverage quarter, the Participant may be allowed to make
self-payments of contributions if the Participant is in danger of losing eligibility due to a period of
To be eligible to make self-payments, the Participant must be available for work at covered employment in the
Industry with an Employer who participates in this Fund. If the Participant is otherwise eligible for
employment with a contributing Employer but failed to work for such Employer for reasons of their own choosing
and for more than four (4) weeks in any consecutive twelve (12) month period [a total of more than twenty (20)
regular work days - Monday through Friday], then the Participant is considered as having "stopped working"
unless the Participant is fully retired.
Self-payment is equal to the minimum amount the Trustees determine is necessary to support the Plan, reduced
by any remaining accumulated dollars in the Participant's DB and HRA accounts.
Self-payments must be received at the Plan’s Office by the 1st of the month of the coverage quarter for which
the payment is due. All Notices are sent to the last known address on file at the Third-Party Administrator's
Office. It is the Participant's responsibility to report any change in address immediately to the Third-Party
Eligibility by means of self-payments can be continued for a maximum of four consecutive coverage quarters.
However, if the industry is suffering from an extended period of widespread unemployment, the Trustees may
temporarily allow self-payment of contributions for more than four consecutive coverage quarters. If a
Participant fails to maintain eligibility by making self-payments, any balance in the Participant's DB and
HRA accounts will be reduced to zero.
When the Participant is eligible by self-payments, the Participant and their eligible Dependents are covered
for the same benefits as all other Fund Participants; all normal Plan provisions apply.
- Will you notify me when I become eligible for benefits?
Yes, you will receive a packet of information from the Fund Office when you become eligible for benefits. Please
read the material carefully and return all forms that need completed as soon as possible so that your benefits
are not delayed in any way.
- What are the quarterly eligibility statements for?
- At the beginning of each quarter you will receive a statement that shows if you are eligible or ineligible for
benefits for the current quarter. Please check the statement to make sure that your employer has contributed all
hours correctly on your behalf.
- What do I do if all or none of my hours have not been reported?
- Contact your employer right away and have them remit the benefits to the Fund Office.
- What information do I need to provide to the doctor’s office or hospital when I go for a visit?
- You will need to provide a copy of your Wellmark ID card.
- How can I find out what doctors are in the network?
- For a list of doctors and other healthcare providers you may contact Wellmark at 800-524-9242 or visit the website www.wellmark.com.
- Do I need authorization for doctor visits?
- Authorization is only needed for hospital inpatient stays or all outpatient surgeries. Please contact Wellmark for further information regarding preauthorization.
- Can you give me information on the prescription drug program?
- The Plan offers prescription drug benefits through a Pharmacy Benefit Manager (PBM), Optum ℞. You must show
your prescription drug ID card when you fill your prescription at a participating pharmacy to receive your
prescription drug medications at discounted prices. You will have to pay the entire cost of the prescription
medication if you do not use a participating pharmacy. To obtain a listing of participating pharmacies please
visit the website at www.optumrx.com or via
phone at 800-524-9242.
- Do I have a mail order drug program?
- Yes, the plan does offer a mail order program for maintenance pharmaceuticals and you can also utilize their
“Medfusion/Ascend Specialty” pharmacy for high cost specialty medications (injectable or tablet). You can contact
Medfusion/Ascend at 800-850-9122 to obtain an estimated cost for your Medfusion/Ascend specialty drugs or mail
- Can I be reimbursed for a prescription if I did not use my pharmacy card?
- Yes, you may receive a partial benefit. You will need to complete a prescription drug claim form and submit to
Optum ℞. You can find a form on this website under the form section.
- What do I need to do when I retire?
- Contact the Fund Office. There are specific eligibility requirements that determine your eligibility for
benefits under the Retiree Health Plan once you retire.
- Can I be covered under the plan once I reach age 65 or if I am on Medicare?
- Once you reach age 65 and are retired or are entitled to Medicare benefits, the Plan will stop providing
coverage regardless of your HRA Account balance and whether or not you choose to purchase Medicare Part B
- Will I be able to elect COBRA Continuation Coverage if I am no longer eligible under the terms of the Plan?
- Under COBRA, you and any eligible dependents may be eligible to make self-payments to continue your coverage
under certain circumstances when your coverage ends - including medical, prescription drug, dental and vision
benefits. The COBRA Continuation Coverage will be the same as the coverage you previously had under the Plan, but
you will not be eligible to continue coverage for short term disability, Life Insurance, or Accidental Death and
Dismemberment (AD&D) Insurance benefits. See your Summary Plan Description for detailed information on COBRA
- At what age are dependent children no longer covered under the plan?
- Coverage will be available to a participant’s eligible children up to the end of the month in which the child attains
age 26, regardless of the child’s marital status, student status, employment status, eligibility for other health
insurance coverage, financial dependency on the participant, or any other factor other than the relationship between
the child and the participant.
This is a self insured/self-funded plan. There is no extra charge for covering dependents.
- How do I add a dependent to the plan?
- You must request an enrollment card from the fund office and provide a copy of their birth certificate showing
the member as the natural father.
- What is the short-term disability benefit?
- It is a weekly benefit with a limit of $300.00 per week and a maximum period that is payable for 26 weeks.
For Injury on the 1st day of Total Disability
For Sickness on the 8th day of Total Disability
- When would I qualify for short-term disability benefits?
- This benefit applies when a Member has a Total Disability that meets all of these tests:
- Total Disability starts while the Member is covered for this benefit.
- Total Disability is being continuously treated by a Physician. (A chiropractor is not considered a
physician for the purpose of disability benefits.) No benefits are payable for any period of time for which
the Member is not under the regular care and attendance of a physician.
- Total Disability is due to an Injury or Sickness that, in either case, is non-occupational that is, not
arising from work for wage, profit or barter.
- Total Disability (Totally Disabled) means the complete inability to perform any and every duty of the
Member's occupation or of a similar occupation for which the person is reasonably capable due to education
and training, as a result of Injury or Sickness.
Starting with disabilities that begin on October 1, 2018, the short-term disability benefit will also be payable for a
female employee’s disability due to pregnancy. Benefits are payable for six (6) weeks for a normal delivery and eight
(8) weeks for a Cesarean section.
The same rules that apply to disabilities due to injuries and sicknesses will apply to pregnancy-related disabilities.
For example, disability benefit claims must include a statement from the patient’s physician stating the date the
disability began and ended (or is expected to end). In addition, the disability must start while the participant is
working on a regularly scheduled basis.
- Why am I receiving an accident request form?
- The Fund Office is required to make sure the Plan is the responsible party to pay the medical claims. When the
office receives a claim with a diagnosis that could be a result of an accident, whether it be auto or work
related, they need your help in explaining what happened. All you need to do is complete the form and return it
to the Fund Office. Once the Fund Office receives the accident form they will review to make sure it meets all
plan guidelines and determine if coverage is available.