Frequently Asked Questions
You can file a claim online using this form.
You will need to complete the Enrollment Addition Form and Spouse Form as well as supply a copy of the new Marriage certificate, Birth certificate and Social Security card(s).
You can find a list of participating providers at this link.
If you have additional questions, you can contact our office for assistance.
If the diagnosis on the claim involves an injury of any kind we need to find out the details of the incident. We will request an Injury Detail form to verify if there is any third party involvement. You must fill out and return the form if requested, or there will be a delay in processing your claim.
Your Surviving Spouse may continue coverage so long as your Surviving Spouse was covered as a Dependent under this Plan on the date of your death.
If, at your death, there are contributions in your Dollar Bank, the monthly payment for your Surviving Spouse’s coverage will be deducted from your Dollar Bank. Once the Dollar Bank is exhausted, your Surviving Spouse may purchase Surviving Spouse coverage. This coverage will require your Surviving Spouse to self-pay by the first day of each month.
Coverage for your Surviving Spouse will end at midnight on the day in which the Surviving Spouse remarries, when the Surviving Spouse fails to pay the required self-payment, or at midnight on the day in which the Surviving Spouse dies.
A Surviving Spouse may not regain coverage following a coverage lapse. If your Surviving Spouse’s coverage terminates for non-payment, your Surviving Spouse will be sent a COBRA Notice and have the opportunity to elect COBRA Continuation Coverage.
That is up to you but you must remember that the day you retire and are eligible for Medicare you must be enrolled in Medicare Part A and Part B.
No, you will have a prescription Part D program through Humana with the Plumbers & Steamfitters Local 33 Welfare Fund.
You can sign up for the member portal on the Local 33 website. You can see information regarding your health insurance, you may view or print your work history and you may view pension information, as well.
Due to HIPAA guidelines, everyone over the age of 18 must create their own account in the member portal.
Yes, for an additional monthly premium you can add medical and prescription coverage for your dependents.
Your eligibility will be reinstated at 12:01 a.m. on the first day of the month following the date the Plan receives employer contributions sufficient to pay the cost of the Plan. Reinstatement in the Plan is done on a prospective basis only.
Example: You worked 126 hours in June. Your employer will report those to us by July 20th and you will be eligible for health coverage effective August 1st.
As a helper, we require 400 reported hours to become eligible again. Hours are reported by the 20th of the month following when you worked them. Once a total of 400 hours are reported, then you would become eligible on the first day of the next month.
The Health Reimbursement Account or HRA will reimburse your eligible healthcare expenses on a tax-free basis.
After your Dollar Bank has reached the six-month capacity, future employer contributions, in excess of the dollar bank charge, will be deposited into your HRA. Your HRA account will be credited at the end of each month. If your Dollar Bank becomes less than the six-month capacity due to debiting for continued eligibility, future employer contributions will be deposited into the Dollar Bank until the six-month capacity is restored. Once again, after the six-month capacity has been restored, employer contributions will then be deposited into the HRA.
We will process a claim up to 365 days from the date of service. After one year, the claim will no longer be eligible for processing.
You may use your HRA to pay the following types of expenses incurred by you, your Spouse and eligible Dependents:
▪ Medical care Deductibles and Coinsurance;
▪ Dental expenses (except for excluded items or frequency overages);
▪ Up to $1,500 per lifetime per dependent under age 19 for Orthodontia expenses;
▪ Covered Vision or hearing out of pocket expenses (limited to $1,000 calendar year maximum per person for vision expenses);
▪ Up to $1,000 per year per person for Chiropractic expenses;
▪ Up to $1,000 per year per person for TMJ appliance expenses after the $500 annual medical benefit has been reached;
▪ Expenses related to exercise or weight-loss programs and educational classes, including gym or health club membership fees, if your physician has diagnosed you with a disease and the program or class is prescribed as treatment for that disease. (Note that in the absence of both a diagnosis or a disease and a prescribed treatment program, gym membership fees are not reimbursable.)
▪ Retiree Self-Pay premiums; and
▪ COBRA costs.
The Dollar Bank is a program that is designed so that the more you work, the more your Dollar Bank may grow. Contributions that your Employer makes on your behalf are based on the number of hours you work each month and are credited to your Dollar Bank. After your Dollar Bank has reached six-months worth of premiums, future employer contributions will be deposited into your HRA.
No, when you become employed by a non-contributory employer your eligibility under the Plan will be terminated and your Health Reimbursement Account will be forfeited.
If you do not have the amount necessary to cover one month of Dollar Bank Charge, you may self-pay the cost of coverage. The Plan will provide you with a self-pay notice and you will have 30 days from the date of that notice to pay. However, you may not self-pay for your first month of eligibility.
You may continue to self-pay to maintain Plan coverage for up to eight full months and one partial month so long as you remain ready, willing, and available for work. You will be considered ready, willing, and available for work so long as you remain on the out-of-work list at the Union.
Your spouse is not eligible for coverage through this Plan when you legally separate, divorce, or no longer share a permanent residence. Your spouse will be offered COBRA Continuation Coverage. You or your spouse must notify the Fund Office within 60 days of the legal separation or divorce for your Spouse to receive an enrollment form for COBRA benefits.
Local 33 does offer a disability benefit to eligible members of the health plan. A Loss of Time Application is required to be completed by both the member and the treating physician. Once approved, the benefit is available to the member while he/she is unable to work, for up to 26 weeks.
The benefit is calculated on a five calendar day period beginning with the first day of Disability due to injury or the eighth day of Disability due to an illness.
You have quick and easy access to a doctor wherever you are, 24 hours a day, seven days a week, 365 days a year. The online service, provided in partnership with Anthem BlueCross BlueShield, is called LiveHealth Online. LiveHealth Online doctors can answer medical questions, make a diagnosis and even prescribe medication for you, if needed. They can help with minor injuries and common medical ailments like colds, flu symptoms, fevers, allergies, infections, headaches, sore throats, minor rashes and earaches.
The Plan covers the cost of a hearing aid, up to the Hearing Aid Benefit maximum ($350 per ear), per four- year period, for each covered person. Benefit includes fitting and purchase of a hearing aid, if required, which includes expenses for the manufacture of ear molds.
Routine vision coverage is available through the Plan. We offer a flat benefit of $150 per person per calendar year that can be used on routine services and materials.
Yes, you can use up to $1000 additional per person per calendar year for vision out of the HRA account if applicable.
Yes, the plan offers coverage at 50% up to a lifetime maximum of $500 per dependent under age 19. If applicable, you can use an additional $1500 from the HRA per dependent.
If your spouse maintains coverage under an employer-sponsored group health plan, then you may waive coverage under this Plan at the time of your retirement. If coverage is waived, then you may become covered under this Plan again if you notify the Fund Office within 31 days of the date coverage under your spouse’s health plan is terminated. You and your spouse are only eligible for this temporary waiver one-time at the time of your retirement.
You will be charged a $100 copayment, in addition to your Medical Plan annual Deductible and Coinsurance, when you receive care in an emergency room. The charge will be waived if you are admitted to the Hospital within 24-hours of receiving care in the emergency room.
The following rules determine which plan is the primary plan:
▪ A plan that does not have a coordination of benefits rule is always primary;
▪ A plan that covers an individual as an Employee is primary; and
▪ A plan that covers an individual as a laid-off Employee or Retiree or Dependent of such person is primary.
In addition, if an eligible person receives benefits or services pursuant to group or individual automobile policy, then this Plan will be secondary.
If an Eligible Dependent child is covered under more than one plan and the parents are not divorced or separated, the plan that covers the parent whose date of birth occurs earlier in the calendar year (excluding the year of birth) is primary. If the birthday of both parents occurs on the same date, the plan that has covered the parent for the longer period of time is primary.