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QUESTIONS
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ANSWERS
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When do I become eligible
for benefits? |
New Hire Employees (except
Clerks Helpers/Utility
Clerks) Plan A/Plan B will
become eligible to
participate in the plan
beginning the first day of
the calendar month following
their 6th month of
employment. The
required Hours must be
worked in the 5th month for
initial coverage in the 7th
month. New Hire Clerk
Helpers/Utility Clerks will
become eligible to
participate for
employee-only coverage
beginning the first day of
the calendar month following
their 18th month of
employment. |
What family members are
covered?
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New Hire Clerks
Helpers/Utility Clerks do
not have dependent coverage.
Clerks dependent children
will also become eligible to
participate in the plan on
the first day of the month
following the employee's 6th
month of employment.
Your
Spouse/Domestic Partner will
become eligible on the first
day of the month following
the employee's 24th month of
employment.
Spouse, unmarried children
and stepchildren under 19
years of age, some foster
children, and legally
adopted children. Unmarried
children 19 through 24 years
of age who are full time
students with Student
Certification on file. And
unmarried children
regardless of age who are
unable to support themselves
because of mental or
physical handicaps.
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How many hours a month do I
have to work for benefits?
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What is a month? The hours
you work in any one week are
credited to you as of each
Sunday, based on the
standard Industry workweek,
which is Monday through
Sunday. Your monthly hours
are credited to you as of
the last Sunday of each
month.
64 hours: All Clerks Helpers
and Utility Clerks
76 hours: Plan B, Food & GM Clerks,
Plan G
92 hours: Plan A, Food & GM Clerks |
When can I switch coverage?
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During open enrollment each
January. You can change once
in a 5 year period outside
open enrollment. (Except
Plan A employees hired after
March 1, 2004 or Plan B
employees hired after
October 3, 2004) |
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What pre-paid plans are
available? |
Kaiser, PacifiCare (Not
available to Plan A
employees hired after March
1, 2004 or Plan B employees
hired after October 3, 2004) |
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If a claim is denied, how do
I appeal the claim? |
Request an appeal form from
the Insurance Dept. And
follow the directions on the
form. |
Clarify student coverage.
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Students are covered from
age 19 through their 24th
birthday month as long as
they are unmarried and
attending an accredited
school full time. A
completed “Student
Certification”, signed by
the member and School
Registrar, must be on file
each quarter or semester.
To cover the summer months
the member must complete and
sign a “Student
Certification of Intent to
Return to School After
Summer Recess” each year. |
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I have to have surgery, what
should I do? |
Under Indemnity: Use a
contracting hospital and
have doctor call the Review
at 1-800-274-7767 before you
go in.
Under Pre-paid: See Plan
provider.
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I have not received medical
card yet, why?
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Indemnity Plan members
receive a Medical Plan 2000+
card and use providers from
a list. It takes the plans
almost a month after you
become eligible to send out
cards. If you need help you
may call their 800#.
Blue Cross Group 57D72A
1-800-825-1030
Pacificare Group 737
1-800-624-8822
Kaiser Group 1500
1-800-464-4000
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Explanation of billings
received when members are
short hours for medical
coverage
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The COBRA notice is very
important for those members
who have lost eligibility
and wish to continue
benefits. They should
complete the form and mail
it back as soon as possible
with a payment.
If you were on: 1) approved
family leave; 2) paid
vacation; or 3) state
disability or worker’s
compensation, complete the
applicable part of the form
and return immediately. If
on state disability or
worker’s compensation,
submit proof of payment from
the state or the insurance
carrier. If you did work
sufficient hours, copies of
your check stubs should be
submitted. Please read the
form carefully! |
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How long will my benefits
last after I quit? |
If you were on: 1) approved
family leave; 2) paid
vacation; or 3) state
disability or worker’s
compensation, complete the
applicable part of the form
and return immediately. If
on state disability or
worker’s compensation,
submit proof of payment from
the state or the insurance
carrier. If you did work
sufficient hours, copies of
your check stubs should be
submitted. Please read the
form carefully! |
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Disclaimer:
This information has been
written as clearly and
accurately as possible. You
should be aware, however,
that benefits are governed
by master policies,
contracts and Plan
documents. In all cases of
benefit determination or
differences of opinion, the
legal policies, contracts or
Plan documents will prevail.
You can examine the master
policies, contracts and Plan
documents by contacting the
Fund Office. If you prefer,
you can request, in writing,
copies of these documents
for a reasonable fee. The
Fund Office will send you
the documents within 30 days
of receiving your request.
The Fund maintains the
Health Care Plan for the
exclusive benefit of
eligible employees; however,
eligibility for or
participation in the Health
Care Plan is not an
assurance or guarantee of
continued employment.rts
the first of the six month.
Qualifying hours for Clerks’
Helpers, Snack Bar
Employees, and Plan B
Utility Clerks are at least
64 straight-time hours each
month. All Other Job
Classifications need at
least 92 straight-time hours
a month. |
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