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1) When am I
eligible for insurance coverage?
You
are eligible for plan benefits on the 1st day of the insurance
quarter following the contribution quarter in which 300 or more hours have
been contributed on your behalf by a participating employer. Please see
the chart below indicating the designated work and insurance quarters. |
|
CONTRIBUTION (WORK)
QUARTERS |
CORRESPONDING
INSURANCE QUARTERS |
|
OCTOBER,
NOVEMBER, DECEMBER
JANUARY, FEBRUARY, MARCH
APRIL, MAY, JUNE
JULY, AUGUST, SEPTEMBER |
MARCH,
APRIL, MAY
JUNE, JULY, AUGUST
SEPTEMBER, OCTOBER, NOVEMBER
DECEMBER, JANUARY, FEBRUARY |
| **Continued
coverage requires 350 contribution hours.
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2)
What if I don’t
have enough hours in a quarter to continue my coverage?
After you are initially
eligible, you need to maintain 350 hours per work quarter.
If you fall short of the required 350 hours, we may use any reserve
hours in your reserve bank. If
you still do not have enough hours after utilizing your reserve bank, you
may be given the option to self-pay the difference to maintain your
coverage for that insurance quarter.
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3)
What if my
reported hours do not match the hours I actually worked?
You should initially
contact your employer to resolve the discrepancy. If the discrepancy is
not resolved with your employer, please contact the Welfare Fund office
and speak with David Naprstek, Collection Coordinator.
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4)
Is my family
covered for medical care?
Your benefit plan
provides “family coverage”. If you are married or have children, we
require that you submit a copy of your marriage license and copies of
birth certificates for your dependent children. If you should have
additional eligibility questions, please contact the Welfare Fund office.
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5)
What type
of coverage do we have under the plan?
Your benefit plan
includes medical, dental, and vision coverage. Please reference the
schedule of benefits in your plan booklet or directly on this website for
coverage details.
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6)
When is a claim form
required?
A medical and
dental/vision claim form is required on each covered individual once a
year. An additional claim form will be required if charges incurred are
related to an injury or if you or any family member has obtained other
insurance coverage.
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Do
we have a maximum family deductible for medical or dental?
Yes.
Each individual family member has a $250.00 major medical deductible. If
two family members meet their individual deductibles within the calendar
year, the family medical deductible for that calendar year is satisfied.
After the family deductible has been met, eligible charges for all family
members are no longer subject to a deductible for that calendar year.
Each individual
family member has a $75.00 dental deductible (for non-preventative
services). If three family
members meet their individual dental deductibles within the same calendar
year, the family dental deductible for that calendar year is satisfied.
After the family deductible has been met, eligible charges for all family
members are no longer subject to a deductible for that plan year.
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8)
How do I use my Blue Cross Blue Shield (BC-BS) card?
As part of the Blue
Cross Blue Shield of Illinois PPO Network, you have the option of using a
BC-BS PPO physician or hospital and receiving a discounted fee. You should
present your BC-BS card at every visit to a physician or hospital. If the
provider is part of the PPO network, you should not pay any fees at the
time of service.
Your dental policy does
not include any PPO providers.
You do have the option of using BC-BS provider or a non-PPO provider
for you vision card.
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9)
How
do I use my Express Scripts
Prescription Benefit?
As an
Express Scripts participant,
you should present your ID card to any pharmacy you are utilizing. If the
pharmacy is a participant in the Express Scripts program, you will receive a
discounted fee. (Please note: This is not a co-pay program). By using your
card, the charges will be electronically submitted to the Welfare Fund
office for servicing. If you do not use your Express Scripts card, please send the
original prescription receipt to the Welfare Fund office for servicing.
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10) When is
pre-certification required?
Your
plan requires pre-certification for all inpatient hospital admissions. Medical
Cost Management should be contacted at 1(800)367-9938 before all scheduled
hospital admissions. For emergency admissions, contact Medical Cost
Management by the first working day following a weekend emergency
admission or within 48 hours if a weekday emergency admission.
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11)
Is a second surgical opinion required?
Your
plan does not require a second surgical opinion for surgical
procedures but if you do chose to have a second surgical opinion if will
be covered by the plan.
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12) Is
a referral necessary and can I be treated by my doctor?
A
physician referral is not required. You have the option of using a
Blue Cross Blue Shield PPO physician or hospital and receiving a
discounted fee. You also have the option of using a non-PPO provider.
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13)
Who do I contact
with policy questions?
You
should contact the Welfare Fund Office directly at (630) 734-0074 with any questions regarding your coverage. The
Office hours are Monday - Friday 8:30am - 4:30pm.
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14) Who
do I contact to check the status of a bill or claim?
You
may contact Blue Cross Blue Shield directly at 1(800) 571-1043, or the
Welfare Fund Office for claim status on any PPO claims. For all non-PPO
claims, please contact only the Welfare Fund Office.
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15)
What do
I need to do if I am injured on the job?
If you are injured on
the job, you should notify your employer directly.
You should also contact the Welfare Fund office, so we are aware of
your injury.
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