Health & Welfare Benefits


Plan "EIN" Number Assigned by IRS: 36-2510895

FUND OFFICE

309.794.1170 (Press 2 for Benefit Office)
7:30 am - 4:30 pm (Central Standard Time)

FUND FAX

309.788.8335

WELFARE OFFICE

Administrator:
Michael Wilcher ext. 242

Fund Contacts:
Sheila (Health & Welfare Eligibility/Claims) ext. 234
Tiffany (Health & Welfare Claims) ext. 237

NOTE: You must provide your 4-digit PIN number that you assigned on the Consent Form in order to email the office regarding claims/eligibility. If you do not have a Consent Form on file (required for all persons 18 years of age or older), you may print one from this site. We will answer your email with a password-protected response. Your PIN number will be the password.

PROVIDER NETWORK SERVICES

BlueCross BlueShield of Illinois. BC Plan Code - 121 / BS Plan Code - 621
Group #P19833
www.bcbsil.com

HINES AND ASSOCIATES

Pre-certification Services: 1-800-670-7718
Medical Case Management Services

MedTrak

800-771-4648
M-F 8 am 9 pm (CST)
Sat 9 am - 6 pm (CST)
www.medtrakservices.com
Group #: 10002063
Bin#: 800004
PCN#: 008126

Mutual of Omaha - Voluntary Life Insurance Company

Please Contact Plumbers & Pipefitters Local Union #25 Welfare Fund with any questions
1-309-794-1170 (Option #2)
Email Address: sheila@lu25.org

VSP - (Vision Benefit)

1-800-877-7195
www.vsp.com

Frequently Asked Questions

1. When will I become eligible for insurance?

The first day of the calendar quarter after Employer contributions equal the current cost of Initial Eligibility. This amount must be reached within a six consecutive month period. However, once Employer contributions equal 160 times the current cost, you are eligible to make a self-contribution for the difference between the cost of Initial Eligibility and the amount of the Employer contributions, and become eligible on the first day of the next Eligibility Quarter.


2. When will I become eligible for insurance benefits?

An Employee will become eligible on the first day of the calendar quarter after Employer contributions to his Dollar Bank equal the current cost of Initial Eligibility (630 times the current benefit cost). This amount must be reached within a six consecutive month period. However, once Employer contributions equal 160 times the current benefit cost, the Participant is eligible to make a self contribution for the difference between the cost of Initial Eligibility and the amount of Employer contributions, and become eligible on the first day of the next Eligibility Quarter. Note: Initial Eligibility cost is equal to 1 1/2 times the current quarterly cost.


3. What do I have to do once I become eligible?

An Eligibility Packet will be sent to you approximately 3-4 weeks prior to your effective date. The following items must be provided to the Fund Office in order for eligibility for you and your dependents to be activated: Certified copy of Marriage Certificate (Xerox or faxed copies not acceptable). Copy of filed Divorce Decree (if applicable), completed Enrollment Form, Spouse Employment/Insurance Verification Form (if applicable), and Adult Child Form (if applicable). If the necessary documentation is not received within 31 days of your effective date, late enrollment will apply.


4. What do I do if I have lost my prescription or medical card?

Contact the Fund Office at (309) 794-1170 #2 between 7:30 am and 4:30 pm Monday through Friday to request new cards. You may also email the Fund Office using the email link provided in the H&W Benefits Section of this website.


5. How do I know if my doctor or hospital is a Participating Provider?

Ask the physician or hospital if they particpate with Blue Cross/ Blue Shield (BCBS) or Illinois, or, go to their website: www.bcbsil.com and look for "Provider Finder", select "PPO" in the drop down menu. You can then search by provider name, specialty, or geographical area.


6. Are second opinions covered by this insurance?

Yes, second and even third opinions are covered under the Major Medical benefits.


7. My spouse/dependent has primary coverage, can I get reimbursed for their prescription co-payment?

Yes, if the primary carrier's co-payment exceeds this Plan's prescription co-payment. To do so, you simply mail in the prescription printout that you receive when you pick up the prescription. This must include the following information: Pharmacy name, Patient name, Drug, Dosage, Original Charge, Amount Paid by primary insurance and the co-payment. If this information is not included, you should request that the pharmacist print out the prescription information.


8. What happens when I or my dependent becomes eligible for Medicare?

Medicare becomes your primary carrier on the first of the month that you turn 65 unless your birthdate is on the 1st of the month, then you become eligible for Medicare on the first of the PRIOR month or, usually 24 months after you are approved for Disability Social Security benefits. You must take Medicare Part A (hospital = free) and B (physician/lab). Individuals no longer have prescription coverage through this Plan once they become eligible for Medicare. You will be eligible to purchase Medicare Part D through Humana when you initially become eligible for Medicare. If you do not elect Medicare Part D that is offered through Humana when initially eligible, you may not do so in the future.

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