Frequently Asked Questions
Welfare Fund Home
When am I eligible for health insurance
benefits?
I understand that my insurance coverage is through the
Local 701 General Welfare Fund. Why do I have a Blue Cross/Blue Shield ID card?
Do I need a referral to see a specialist?
I’m not sure what benefits are provided under
the Plan.
What is pre-certification and who is Med-Care Management?
Do I need a second opinion before I have any procedure
performed?
When do I need a claim form?
What should I do if someone in my family has other
insurance?
I have a drug card from
SavRx. How
does that work?
My pharmacist said that my prescription was not
covered. How could that happen?
Should I show my BC/BS card to my dentist?
What should I do if I lose my ID cards?
What happens if there is a change in my family?
What if I am injured at work?
My child went to see a doctor while she was away at college and the
Fund denied her claim. Why is she no longer covered?
Is my spouse dropped
from the plan when she has her own insurance?
What if my spouse quits or gets laid off from
his/her job?
My spouse is also covered by Blue Cross
Blue Shield (BCBS). Will BCBS automatically file under my plan as secondary?
Where can I go for
eye care? Does the BC/BS network offer any vision
providers?
Are school physicals covered?
When am I eligible for health insurance
benefits?
A. If you are a Local 701 apprentice, or a Local 701 member
reinstating lost insurance benefits, you will be eligible after working at least 300 hours
in a contribution quarter. Eligibility begins on the 1st day of the month
following your 300th hour in that quarter.
If you are not a Local 701 member,
you must work at least 800 hours in a consecutive 6 month period to be eligible for health
insurance benefits. Eligibility begins on the 1st day of the month following
your 800th hour.
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I understand that my insurance coverage is through
the Local 701 General Welfare Fund. Why do I have a Blue Cross/Blue Shield ID card?
A. In order to offer a wide range of options for our
participants, and obtain services at more advantageous prices, the Fund uses the
Blue Cross/Blue Shield (BC/BS) PPO network of providers. The PPO allows you access to a wide
range of providers who have agreed to provide services at discounted prices. You should
use PPO providers whenever possible. You will be saving money for the Fund and yourself.
In the event that you can not find a provider that you are satisfied with, the Fund still
provides coverage for services outside the BC/BS network.
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Do I need a referral to see a specialist?
A. You do not need a referral to see a specialist. Under a PPO or a
private insurance plan you do not have a primary care physician as you would have under
most HMO’s. You are free to see any provider you choose. Choosing in-network
providers will result in the greatest savings for you though.
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I’m not sure what benefits are provided under
the Plan.
A. To find out more about your Welfare Fund benefits, you should
read through your Summary Plan Description (SPD) booklet. You can also review the Schedule of Benefits on our website . If you
have specific questions you can call the fringe benefit office at (630)
393-1701.
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What is pre-certification and who is Med-Care Management?
A. Pre-certification means that any
non-PPO hospital confinement,
surgical procedure, physical and occupational therapy which exceeds 25
visits following a covered medical procedure or 12 visits for a covered
medical condition, mental/nervous or chemical dependency treatment must be reviewed, so
that both you and the Fund can be sure that you are receiving the most appropriate
treatment for your condition. Med-Care Management is the provider that the Fund uses for
pre-certification. They can also assist you if you need special services such as nursing
care, or rental or purchase of durable medical equipment.
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Do I need a second opinion before I have any procedure
performed?
A. The Plan does not require a second opinion, however, you
must call Med-Care Management for pre-certification on all non-PPO in-patient
hospitalizations, all surgical procedures, mental / nervous services or chemical
dependency services.
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When do I need a claim form?
A. The Fund requires that you submit a blue annual claim form once
each year. This form includes space for all family members, you do not need separate forms
for each dependent. Occasionally, we may request additional information on a specific
claim or to clarify a confusing situation. If we do, you should complete a white universal
claim form. Additionally, when you wish to make a claim against your Medical Savings
Account (MSA) benefit you should use a white universal claim form. The white claim form is
used for medical, dental, vision and MSA claims. (back
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What should I do if someone in my family has other
insurance?
A. If your spouse has other medical, dental or vision
insurance, the company providing that coverage is considered ‘primary’ on your
spouse. You should submit all claims for your spouse to his or her ‘primary’
insurance carrier before you submit them to us. Once you have received an Explanation of
Benefits (EOB) from that carrier, you may submit the claim to the 701 Welfare Fund to
determine if there will be any additional reimbursement.
If your
spouse’s insurance also covers your dependent children, the Plan applies the
‘birthday rule’. This means that whichever parent’s birthday falls first
during the calendar year will be considered to be the ‘primary’ carrier on the
eligible dependent children.
If your children are covered under another medical, dental or vision due a divorce,
generally the divorce decree will dictate which insurance plan must act as the primary
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Q.
I have a drug card from SavRx. How does that work?
A. The Fund uses SavRX
for pharmacy discounts. When you show your
card at participating pharmacies, you pay only a co-pay, depending
on whether your prescription is generic, preferred or non-preferred
brand name.
Use of retail pharmacy is mandatory for first two fills of a long-term or
maintenance medication. Mail order is mandatory for the fourth and all
subsequent fills.
| Generic Drugs |
20%; minimum $10/ maximum $15 |
| Preferred Brands |
20%; minimum $15/ maximum $25 |
| Non-Preferred Brands |
20%; minimum $20/ maximum $40 |
You can receive up to a 30 day supply
on one prescription fill.
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My pharmacist said that my prescription was
not covered. How could that happen?
A. The Plan allows only two refills on all prescriptions. If
your medication is a drug which you will be taking for an extended period of time, you
must use Sav-RX’s mail order drug program after you have exhausted your refills. If you
do not use the mail order program, you must obtain a new prescription from your pharmacist
after the second refill.
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Should I show my BC/BS card to my dentist?
A. BC/BS has very few dental providers in it’s PPO network. Unless you are
seeing an oral surgeon or other specialized dental provider, he or she will not be in the
network, and will not need to see your BC/BS card. Dental claims should come directly to
the Fringe Benefit Office. If you do see a specialist, you can contact the Benefit Office
or BC/BS to determine if your provider is in the network. (back to top)
What should I do if I lose my ID cards?
A. Contact the Fund Office to report the loss. New cards will
be sent out within a few days.
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What happens if there is a change in my family?
A. If you have a baby, adopt a child, get married or divorced,
you will generally need to complete a new dependent card. This can be obtained by
contacting the Fund Office. We will also need copies of the birth certificate, adoption
document, marriage license, or divorce decree. If you have a change related to your other
insurance coverage on your spouse or other eligible dependents you will need to complete a
white universal claim form for that person, indicating the change that occurred. If other
insurance is terminating, you will need to provide a termination letter from the other
insurance carrier indicating the date of termination and the type of coverage which is
terminating. Contact the Fund Office for more details. (back
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What if I am injured at work?
A. The Plan does not cover work related injuries, because these
should be covered by your employers workers compensation carrier. If you are injured on
the job, you should notify your employer immediately so that an accident report can be
completed. Notify the Fund Office as well. If you should have trouble collecting your
benefits through the workers compensation carrier, call the Fund Office to make special
arrangements. (back to top)
My child went to see a doctor while she was away at college
and the Fund denied her claim. Why is she no longer covered?
A. Dependents over the age of 19 are not covered under the Plan
unless they are full time students at an accredited college or university. If your
dependent is a full time student, you must submit a Full Time Student Status Verification
form, completed by the college, at the beginning of each semester. Upon completion of each
semester, you must submit a copy of the student’s report card to verify that the
semester was completed. Dependents who are full time students can continue coverage until
their 25th birthday or for three months after they cease to be full time
students, which ever comes first. (back to top)
Is my spouse dropped
from the plan when she has her own insurance?
A. No. Our Plan
considers benefits secondary to your spouse's plan. In most cases, between
the two plans, eligible charges will be paid in full. You will not have any
out of pocket expenses. Request providers to bill Blue Cross Blue Shield
(BCBS) after your spouse's plan has made its payment. If the provider will
not bill BCBS, you can send the itemized bill and explanation of benefits
(EOB) from the primary plan directly to BCBS for processing. Be sure to
include your BCBS unique ID number and our Plan number P81221. You can send prescription
receipts or print-outs for the co-pays for your spouse's prescriptions
directly to the Fund Office for consideration.
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What if my spouse quits or gets laid off
from his/her job?
A. If your spouse is no longer employed this plan will
become his or her primary plan when his/her insurance terminates due to
termination of employment.
My spouse is also covered by Blue
Cross Blue Shield (BCBS). Will BCBS automatically file under my plan as
secondary?
A. At this time, BCBS does not have the capability to do this. It
is best to have the providers bill both BCBS plans.
Where can I go for eye care? Does the BC/BS network offer any
vision providers?
A. BC/BS does not provide vision benefits. The Plan uses the
NVA (National Vision Administration) network for eye care discounts. You can call
NVA at 1-800-672-7723 to
obtain the names of providers in your area. If you choose not to use one of the providers
in the NVA network, your benefits are limited to those detailed in the Summary Plan
Description. Benefits are greater when in-network providers are used.
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Are school physicals covered?
A. The Plan offers a wellness benefit of up to $2000.00 per
year for each family. This includes annual physicals for adults and children as well.
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