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Q: When will I be eligible for medical coverage?
A: If you work at least 100 hours in a month, you will be eligible for benefits on the first day of the third month following the work month; however, all required enrollment applications must be completed and submitted to the Trust Fund Office before coverage will begin.
Example: If you work 100 hours in September, you will be eligible for benefits
effective December 1st.
Q: I have medical coverage through HMSA, why was I unable to pick up prescription drugs?
A: For members with HMSA coverage, your prescription benefits are provided through Express Scripts. You must present your Express Scripts card to your pharmacist when filling a prescription.
Q: I forgot to show my Express Scripts card when picking up prescriptions and had to pay full price. What could I do?
A: You could complete a prescription drug reimbursement form obtained from the Trust Fund Office and submit it with a copy of the pharmacy receipt for claim reimbursement.
Q: I have not received an Express Scripts card. How could I get one?
A: You could contact the Health & Welfare Department at 841-7575 and request for an
Express Scripts card. A new card will be generated by Express Scripts and mailed to you.
Q: How could I continue my medical plan once I lose coverage due to lack of work hours?
A: You may elect continuation of coverage under COBRA and self-payments must be made on a monthly basis. The COBRA Notification/Election letter will be mailed to you the month prior to you losing eligibility.
Q: Do I have to notify the Trust Fund Office if my marital status changed?
A: Yes. It is important that you keep the Trust Fund Office informed of any changes that may affect your family's medical coverage such as marriage/divorce, dependent (a new baby or an adopted child), and/or disability status change. Changes to your contact information such as address and telephone number are also very important.
Q: What is the difference between workers' compensation and temporary disability insurance (TDI)?
A: Workers' compensation is when you become disabled and unable to work because of an occupational disability. Temporary disability insurance is non-occupational, accidental bodily injury or sickness.
Q: Am I able to put my grandmother and/or partner on my medical plan?
A: No. The Carpenter's plan does not provide domestic partnership or reciprocal beneficiary coverage.
Q: I need to report a death, what information do I need to provide?
A: The Certificate of Death from the Department of Health and your contact information (e.g. phone number).
Q: Is there a deadline to file for a chiropractic or vision claim reimbursement?
A: Yes. All chiropractic and vision claims must be filed within 90 days of the date of service.
Q: Which carrier is my vision benefit through?
A: If you have HMSA medical coverage, then your vision beneift is through the Carpenters Health & Welfare Fund. You can call the Trust Fund Office to check on eligibility and partipating providers. If you have Kaiser medical coverage, then your vision benefit is through Kaiser. You should contact Kaiswer to check on eligibility.
Q: Which carrier is my chiropractic benefit through?
A: You must have level 2 coverage for chiropractic benefits. The chiropractic coverage is through the Carpenters Health & Welfare Fund. You can call the Trust Fund Office to check on eligibility and participating providers.
Q: When should I notify the trust fund office if I receive a work-related injury?
A: The Trust Fund Office must be notified in writing within 30 days from your date of injury or 30 days from the date you lost active coverage.
Q: How long will it take to reach level 2 coverage?
A: You must be on level one (1) for three (3) consecutive months of active coverage before the level will increase. You will reach level 2 on the 4th month of active continous coverage.
Q: Can I make COBRA payments over the phone?
A: No, COBRA payments must either be mailed to the Trust Fund Office or brought into the Office. COBRA paymetns must be submitted via personal check, money order or cashier's check. Cash or credit card payments are not accepted.
Q: What happens if I do not elect COBRA to continue my coverage?
A: If you have a break in coverage and do not elect COBRA, when you resume active coverage through work hours, your coverage will start at level 1 active coverage.
Q: I was on level 2 benefits and lost coverage. Does the COBRA plan I elect affect the level of benefit I will be on when I resume active coverage through work hours?
A: To maintain your level 2 active benefit when you regain eligibility through work hours, you must elect and pay for level 2 COBRA coverage.
Q: My wife and I have a newborn, how do I add him/her to my medical plan?
A: To add a newborn, you must provide the Trust Fund Office with a certified birth certificate or hospital birth acknowledgement/certification within 30 days of your child's birth.
Q: What is the effective date of my new dependent's coverage?
A: For coverage to be effective on the day of the qualifying event such as date of marriage or birth, you must notify the Trust Fund Office within 30 days of the date of marriage, birth, adoption or placement for adoption and provide the proper documentation such as a copy of the marriage certificate or marriage license signed by an officiant, birth certifcate or hospital birth acknowledgement/certification. If you do not notify the Trust Fund office within this 30-day period, coverage for your new dependent will not be effective unil the first day of the month following the date of notification.
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