1. When will I be eligible for insurance benefits?
You will become eligible for insurance benefits on the first day of the three month benefit quarter, if you have 300 credited hours during the related three month eligibility quarter.
See Initial Eligibility :
300 Credited Hours
in this Eligibility Quarter
Makes You Eligible
in this Benefit Quarter
April - May - June September - October - November
July - August - September December - January - February
October - November - December March - April - May
January - February - March June - July - August
2. How can I add a dependent?
Call the Benefit Fund Office and request a “DEPENDENT ADDITION FORM”. You will need a marriage license to add a wife and a Birth Certificate to add a child. State or County copies only.
3. What if I am not currently working?
Refer to the Eligibility Chart. If you work over 300 hours in a specific eligibility quarter those extra hours are “banked” for up to 300 more hours. When all of these hours are used and you are still not back to work, you are offered Cobra Continuation Coverage for up to 18 months if needed. See Cobra Coverage Self-Payments.
4. When can I switch from PPO to HMO or from HMO to PPO?
Open Enrollment is every March 1st. Information is sent out in late January, to be returned by mid-February.
5. What if I do not agree with the hours remitted by the contractor?
You should contact your Business Agent or Employer.
6. How do I obtain benefits?
If you have elected HMO(Aetna) coverage you should contact the following:
Medical and RX
– HMO provider
1-888-416-2277
Dental – Delta Dental 1-630-964-2400
1-800-323-1743 (IL)
1-800-331-0538 (outside of IL)
If you have elected Indemnity coverage you should contact the following:
Medical – BCBS of Illinois 1-800-571-1043
Vision – Vision Service Plan 1-800-877-7195
Dental – Delta Dental 1-630-964-2400
1-800-323-1743 (IL)
1-800-331-0538 (outside of IL)
RX – SAV-RX 1-800-396-2219
The Benefit Fund office may be contacted as well 1-630-960-5572
1-800-760-9191
7. If I become disabled, can I receive disability benefits from the Welfare Fund?
If you become disabled due to a non-occupational accident or sickness while you are eligible for benefits, you are entitled to $250.00 per week from the Welfare Fund. If your disability is due to an accident or if you are confined to a hospital, payment begins on the first date of your disability. If your disability is due to a sickness and you are not confined to a hospital, payment begins on the eighth day.
No benefits are payable by the Welfare Fund for a work related disability. If you are injured on the job, you should contact your employer immediately. All claims should be filed through your employer’s workers compensation carrier.
8.If I become disabled will I lose my insurance?
If you are eligible for benefits at the time your disability begins, you may be entitled to an extension of your benefits, at no cost to you, for up to twenty-four months. If your disability is due to a work-related injury, you will have to submit copies of your workers compensation check stubs. If you become disabled, please contact the Fund office for an application and to verify if you are eligible for this benefit.
9.What is my deductible under the Indemnity Plan?
If you use a PPO provider there is a $100.00 calendar year deductible, per person. The family deductible is $300.00 per calendar year.
If you use a NON-PPO provider there is a $200.00 calendar year deductible, per person. The family deductible is $600.00 per calendar year.
Please refer to page twenty-eight of your Summary Plan Description Booklet.
10. What are my benefits under the Indemnity Plan?
If you use a PPO Provider, benefits are paid at 90%. If you use a NON-PPO Provider benefits are paid at 80%.
Some benefits have special limitations. Please refer to page twenty-eight to thirty-three of your Summary Plan Description Booklet for a complete description of your coverage.
11.Do I need a referral under the Indemnity Plan? Do I have to be treated by a particular doctor in the Plan?
You do not need a referral under the Indemnity Plan. You can use the doctor of your choice. If you use a doctor in the PPO Network, benefits are paid at a higher percentage rate. Please refer to pages twenty-eight through thirty-three of your Summary Plan Description Booklet for a complete description of your benefits.
12.How are prescriptions paid under the Indemnity Plan?
If you need to purchase a one-time prescription, purchase the prescription from your pharmacist and submit the pharmacutical label to the Fund Office for reimbursement. Benefits for prescriptions are paid under the PPO Plan at 90% after your $100.00 calendar year deductible has been satisfied. If your pharmacist participates with SAV-RX and you show your prescription card, you should receive a discount off the price of the drug.
If you are taking a medication regularly that needs to be refilled every month, you should purchase the prescription through the mail order with SAV-RX. This will save you and the Fund money. You can purchase up to a ninety-day supply for a co-pay of $5.00 for generic drugs and 10% of the cost or $15.00 (whichever is less) for brand name drugs.