Frequently Asked Questions
Welfare FAQ | Pension FAQ
To view FAQs by category, click on any of the items below:
Disability Benefits
Q: When am I eligible to collect disability benefits?
A: You are eligible on the eighth day after the first day of treatment. The attending physician must deem time off from work as medically necessary.
Q: How do I apply for disability benefits?
A: You must advise the Fund Office of your disability and request a disability claim form. When you receive your disability claim form, you will need to complete your portion and have your supervisor complete the company portion. It is best to wait approximately 2 weeks to have your doctor complete his/her portion due to the seven-day wait period. When a member is off from work due to illness (occupational or non-occupational), it is the member’s responsibility to pay his/her union dues.
Q: What do I do when I receive my disability check with an intermediate report of disability form?
A: This is the continuation form for disability. You must complete the top half of the form and your doctor must complete the attending physician portion. This form is a repeat procedure until your are able to return to work. Please keep in mind that the attending physician can not complete the last form (prior to your release to return to work) any earlier that 3 days prior to your release date. Disability benefits through this office are for non-occupational illness or injuries only. There is also a portion of page two that your employer needs to fill out.
Q: How much will I receive and for how long can I collect disability if I can not return to work?
A: You are eligible for $250.00 per week. Social Security taxes are taken out of each disability payment. You are eligible for 26 weeks of disability, thereafter, your benefits will terminate if you are unable to return to work.
Q: If I become injured at work what do I need to do?
A: You need to file a workmen’s compensation claim with your employer. If the workmen’s comp insurance carrier denies the claim stating the injury was not due to a work-related incident, you will need to submit to the Fund Office a letter of denial. You will then be required to complete a subrogation and reimbursement agreement form in order for the Fund Office to process your medical claims.
Eligibility
Q: I am a newly hired employee when do I become eligible for health insurance benefits?
A: Your employer will not make any contributions for you for the first 30 days of your employment. Then, you will become initially eligible on the first day of the month which coincides with or next follows a period of 2 consecutive months for which full contributions have been made to the Fund on your behalf by a participating employer. This date is called your "initial eligibility date".
Example 1
If you start work on June 1. Your employer will not be required to make contribution for you for the first 30 days. In this case it will be all of June. If you continue to work and your employer makes full contribution for you for all of July and August, your initial eligibility date would be September 1.
Example 2
If you start work on June 15. Your employer will not be required to make contribution for you for the period of June 15 through July 15. You continue to work during July, but since your employer does not make contributions for the full month of July, that month does not count toward gaining initial eligibility. If you continue to work and your employer makes full contributions for you for all of August and September, your initial eligibility date would be October 1.
Dependents
Q: How long can my children continue health coverage under my policy?
A: Your child, at age 19 up to age 23, can continue to be eligible for health insurance benefits if he or she is enrolled full-time in a state-accredited secondary school, university, college, trade school, etc., is dependent on you for the major portion of his or her support, and maintains a permanent residence in your home.
-OR-
If your child is age 19 or older, is incapable of self-sustaining employment because of mental incapacity of retardation or physical handicap and meets all of the following conditions: your child must meet the definition of a dependent child except for age: your child must be incapable of supporting himself due to his or her handicap: and your child must be primarily dependent upon you for support. If your child meets these conditions, and continues to meet these conditions, he or she will be covered under the Plan as long as you remain eligible. Proof of your child’s handicap or continued handicap may be required.
Q: Who is considered a child under this Plan?
- A child born of a valid marriage of yours;
- With respect to a female employee-a child born to you;
- With respect to a male employee:
A child of yours not born of a valid marriage either for whom you may have been determined to be the legal parent, or you are listed on the child’s birth certificate as the father and later marry the child’s mother (in which case such child’s coverage will begin on the date of your marriage to the child’s mother);
-OR-
A natural child of yours who is not a child born of a valid marriage of yours, provided the child is recognized by the Trustees as an "alternate recipient" under the terms of a court order which the Trustees determine to be a Qualified Medical Child Support Order or provided that you have paternity papers on such child. The Fund Office will require a copy of either legal document before claims for the child will be considered for payment.
- A child for whom you have legal guardianship, or a child legally adopted by you or placed in your home for adoption (provided that the child lives with you in your home in a regular parent-child relationship).
- A stepchild of yours, meaning any child of your spouse who was born to your spouse or who was legally adopted by your spouse before your marriage to your spouse, provided that the stepchild is dependent on you for the primary portion of his support and maintenance and lives with you in a regular parent-child relationship.
Q: How do I add my spouse, children and/or stepchildren?
A: Spouse - You will need to submit to the Fund Office a certified copy of your marriage certificate, your spouse’s birthdate, a copy of the social security card and other insurance, if any.
Child: To add your child you must provide the Fund Office with a copy of the child ‘s birth certificate and social security card.
Stepchild: To add your stepchild you must provide the Fund Office with a copy of the child’s birth certificate and social security card as well as a copy of your spouse’s divorce papers.
Q: What are the benefits for new born?
A: For newborn child we pay 100% up to $1,000.00 for the first 7 days, no deductible. If your newborn becomes sick we pay at 80% after the $500.00 deductible is satisfied.
Q: What do we need to file if my spouse has other insurance?
A: You need an itemized bill, and the explanation of benefits from the primary insurance.
Vision
Q: Where can I go for eyecare? Does the BlueCross BlueShield Plan offer any discounts?
A: You are free to go to any eye care facility. Most facilities will expect payment at the time of service. Therefore, you will need to submit a completed vision claim form to the Fund Office along with an itemized bill for reimbursement according to the Plan Benefits. Blue Cross Blue Shield does offer a discount plan. By presenting your Blue Cross medical card you will be entitled to a discount at the time of service. Afterward, you can submit the remaining amount to the Fund Office for reimbursement according to the Plan Benefits.
Dental
Q: What’s the difference between the two dental plans offered.
A: The first plan is our self-funded dental plan offered through Local 734.
You are automatically on this plan unless you specify otherwise. This plan allows you to see any dentist you want. Your dental bills will be covered at 90% up to $1,500.00 per calendar year. There is a $50.00 deductible for major and basic dental work performed by the dentist. This deductible does not apply to routine cleanings.
Our second dental plan is offered through BC/BS HMO. The HMO plan requires that you use the dentists listed in their network. You will need to contact the Fund Office for a pamphlet and enrollment form. Open enrollment is in August. Once you sign the enrollment form you are committed to BC/BS for one year. You will remain on this plan unless you notify the Fund Office that you wish to be removed from the HMO plan during the enrollment period in August.
Q: How do I remove myself from the BC/BS HMO plan?
A: You must notify the Fund Office in writing stating your request to be removed.
Q: Do you cover braces? Is there an age limit?
A: The Plan covers orthodontia at 90% PPO, 80% Non-PPO up to a lifetime maximum of $2,000. There is no age limit.
Medical
Q: When do I need to complete a medical claim form?
A: You do not need to fill out Medical claim forms.
Q: Do I need a referral to see a specialist?
A: No, you can go to any specialist in the BlueCross PPO Network.
Q: Where do I send bills from a Non-PPO provider?
A: All bills should go to BlueCross BlueShield of IL, P.O. Box 805107, Chicago, IL 60680-4112
Q: Do I have a Co-Pay?
A: No, the Plan will pay 80% of your medical claims covered under the Plan Provisions after you have met your $500.00 deductible. Afterward, your portion will be 20%.
Q: Will my medical bills be covered if I become sick when I’m away on vacation?
A: If you become ill and need to seek medical treatment in the United States there will be no change in benefits. We will cover your bills at 80% once the $500.00 deductible has been satisfied. If you seek medical treatment out of the United States your medical bills will be covered at 100% up to a maximum of $250.00. Unless it is a life threatening situation, we will then cover your medical bills at the regular benefits.
Q: Will I need a second opinion before I have surgery?
A: You must call Med-Care Management for pre-certification of any inpatient or outpatient surgery. Med-Care will notify you if a second opinion is necessary.
Q: Why do I need to complete a subrogation and reimbursement agreement form?
A: These forms must be completed to determine if there is a third party responsible for payment on medical claims. The subrogation form asks for injury or accident information. The reimbursement form is an agreement made between the member and Local 734 stating that if claims were paid by a third party and also paid by the Fund Office, the member must reimburse the Fund Office on any claims related to the incident.
Q: Are school physicals covered?
A: The wellness benefit pays all routine exams at 100% up to $300.00 per year. This applies to you, your spouse and children under the age of 6. 100% up to $100 per year for children over the age of 6.
Q: Is birth control covered?
A: Oral contraceptives are covered.
Q: Is my deductible the same if I used a PPO provider?
A: Yes, your deductible will still be $500.00
Q: If I pay any bills what do I need so I can get reimbursed?
A: Your BlueCross BlueShield doctor should not request payment at the time of service. But if you are forced to pay you should notify the Fund Office then we can further Assist you. If your doctor is out of the BlueCross Network, you will need to submit an itemized bill to the Fund Office for reimbursement.
Q: How much is my out-of-pocket maximum?
A: The out-of-pocket is $2,000.00 and it does not include your deductible
Q: Do you cover Home Health Care?
A: Yes, you will need to contact Med-Care Management for Pre-Certification required by the Plan.
Q: Do I need to use a Hospital in the BlueCross Network? What would happen if I didn’t?
A: Yes, you should use a Hospital that is listed in the Network. If you decide to go out of network for a non-emergency procedure a penalty of $250.00 will be applied to each claim submitted that is an out of network facility.
Q: Do we cover infertility?
A: We only cover the initial diagnostic test to determine the cause of infertility.
Q: Do we cover speech therapy?
A: Yes, under certain circumstances.
Q: What is my lifetime maximum benefit?
A: The lifetime maximum is $1,000,000.00
Q: Do you coverage cosmetic surgery?
A: Yes, under certain circumstances.
Retiree Coverage
Q: I am a retired member. Do I have health insurance benefits with the Fund Office?
A: Yes, you will need to complete a medical claim form and provide a copy of the itemized hospital, doctor and/or surgeon bill to the Fund Office. The benefits we provided are limited:
- $14.00 per day room & board in hospital (maximum 31 days)
- $140.00 for in hospital or out patient surgery miscellaneous expense
- $250.00 for surgery based on a schedule of surgical procedures
- $1000.00 for life insurance (member’s life only)
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