H&W FAQ's

Health & Welfare
FAQ’s
(Frequently Asked Questions)

  • What is my eligibility requirement for health coverage?

ELIGIBILITY FOR NEW MEMBERS; REESTABLISHMENT OF ELIGIBILITY  FOR MEMBERS

New Members

A new Member of Local 99 will become eligible for benefits coverage under this Plan after he/she has both:

(a) achieved initial Active Member status; and

(b) actively worked in Covered Employment for a minimum of seven  hundred (700) credited hours within a continuous twelve (12) month or less period (“the initial 12 month period”).  This initial 12 month period shall solely apply to new Members of the Plan attempting to establish initial Eligibility for coverage.

A new Member who satisfies these eligibility conditions will become eligible for enrollment in  Healthcare Plan Coverage (see below). 

Members Who Have Lost Coverage

An Active Member of Local 99 who has lost eligibility and coverage for  Healthcare Plan Coverage may subsequently reestablish such eligibility for  Coverage by  accruing seven  hundred (700) credited hours in any period of time .

Newly Organized Journeymen

Notwithstanding the hours requirements set forth above, any newly organized journeyman who achieves Active Member status in Local 99 shall be granted immediate eligibility for coverage hereunder, provided that said member was covered by a health insurance plan through his/her former employer.    However, said newly organized member will thereafter be subject to the Health Care Coverage Continuation Rules set forth in Paragraph (B) below.


CONTINUATION OF COVERAGE FOR ACTIVE EMPLOYEES

Continuation of Eligibility for  Healthcare Plan Coverage

Once a new Active Member of Local 99 becomes eligible for initial benefits coverage hereunder pursuant to Paragraph (A) above, or after an Active Member of Local 99 who has lost eligibility and coverage hereunder subsequently reestablishes such eligibility pursuant to Paragraph (A) above, his/her eligibility for  Healthcare Plan Coverage  will continue as long as he/she is employed by a contributing employer and continues to maintain a minimum of seven  hundred (700) credited hours (the “Credited Hours Bank”) .

  • How can I find out how many hours I have in the last (12) months?

At any time you can visit the H&W Fund office and request a print out of your hours for the last (12) months.  You can also call the H&W Department for this info or sign into Member Services and click on Hours and Transactions.  Just remember that we only have hours that were received from the contractor that you work for.  We will never have hours in house for the previous week or month that you worked because contributions and hours are usually 2 months behind.  Therefore, you will have a true account of your hours before we would.

  • How does my deductible work?

You will hit your deductible if you have any of the following:

Inpatient & outpatient Surgery, Hospital Stay, Air Ambulance, Durable Medical Equipment (DME) & Orthotic Devices, Hearing Aids, Home Health Care & Hospice, XRAY & Major Diagnostics (CT,PET, MRI, MRA & Nuclear Medicine), Scopic Procedures (colonoscopy, sigmoidoscopy, endoscopy), Skilled Nursing Facility & Inpatient Rehabilitation Facility Services, and Therapeutic Treatments - Outpatient.  You will not hit your deductible for office visits, specialists and preventive care.

You have a $2,000 individual deductible and $1,750 is reimbursable through GISC, $4,000 for a family plan, which $3,500 is reimbursable.  You are responsible for the first $250/$500 of your deductible.  This deductible can be handled through the H&W Fund office or you can process your deductible claim directly through GISC.  The claim forms are available in the H&W Fund office.  To process a reimbursable claim, you would need to submit the invoice or statement from your medical provider and submit a copy of the Explanation of Benefits (EOB) that comes from United Healthcare.

After your deductible is met for the year all claims are paid at 100% less your co-pay. 

  • How can I obtain replacement ID cards from United Healthcare, Delta Dental of RI, and Davis Vision?

To obtain replacement ID cards you would have to contact the H&W Fund office and the Benefits Coordinator will have new cards sent to you.  Davis Vision does not administer ID cards; your Davis Vision subscriber ID number is the member’s social security number. 

You can log into www.myuhc.com to obtain additional ID cards for the member and his/her dependents.  Delta Dental of RI only administers ID cards in the member’s name; members do not get ID cards for the dental plan.

  • Do we still have Davis Vision and what is covered under this benefit?

Yes, we still have Davis Vision and one eye exam every 24 months is covered under the Davis Vision plan.  You can also get eyeglasses and contact lenses once every 24 months as well.  You may obtain a summary of benefits from the H&W department.

  • How long am I covered under the medical plan if I am out of work for medical reasons?

Continuation of coverage while sick or injured shall last no longer than one (1) year from the date he/she became unable to work in Covered Employment due to sickness or injury.

  • What is the maximum age that my child/dependant can remain on my medical and dental plan?

The maximum age for a dependent child to stay on the medical plan is age 26 regardless of student verification. 
For the Delta Dental plan, dependent children are covered up until the end of the year that they turn age 19.  Dependent children who are full-time students over age 19 are covered as long as they stay in school until the end of the year that they turn age 23.

  • Will my ex-spouse be covered under my plan when we get divorced?

No, effective February 1, 2010 ex-spouses will no longer be covered under this plan.

  • When does my benefit maximum replenish for Delta Dental?

Your benefit maximum replenishes on a calendar year basis, January 1.

  • I picked up a prescription at the pharmacy and my copay was higher than last time – why?

United Healthcare/OptumRX revises its prescription drug formulary usually twice a year.   Additionally, UHC reserves the right to make changes upon plan renewal and at other times throughout the year. These changes include the movement of drugs from one formulary tier to another, dosage restrictions, pre-authorization requirements and exclusions.

  • What kind of help is available if I need assistance with mental health issues for myself or family?

Crisis intervention, assessment, information and referral services are available for problems which affect your personal and work life. Counselors are available to talk with you about issues such as family and marital difficulties, drug and alcohol problems, mental health concerns, and emotional distress.
Please contact (886) 633-2446.

If you have a question that was not answered on this FAQ’s sheet, always remember that the Benefit Coordinators are available and willing to answer all and every question that you may have.

Nicole S. Natale

Tel: (401) 946-9900 Ext. 242

​Fax: (401) 946-2608

nnatale@ibew99.org

There are always changes that can benefit you and your family.  So we stress and urge you to open and read all material that is sent form the Union.