health reimbursement account


NECA-IBEW WELFARE TRUST FUND NEWSLETTER


VOL. 20, No.2
DECATUR, ILLINOIS
Dec. 2004

Staying the Course

With health care costs increasing steadily over the last few years, the Trustees have been continually monitoring the Plan. As a result, there have been several changes made to the Plan over the last few years to strengthen the Fund’s financial position. The Trustees are pleased to report that these changes are paying off; the Plan is staying on course and heading in the right direction. That means that there are no Plan changes to announce at this time.

The Trustees will continue to monitor the Plan to ensure that this trend continues. You can continue to do your part by:

  • Following the Plan’s coordination of benefits provisions. Be sure to report any coverage that you or your dependents have.
  • Using network providers and participating pharmacies whenever possible for medical, prescription drug, dental, and vision benefits. Network providers have agreed to negotiated rates that are usually lower than non-network providers’ rates. That means that when you use network providers, your total expenses will be lower, which means you pay less and so does the Plan.
  • Requesting generic medications. A generic medication is a copy of a brand name medication that is no longer protected by a patent. By law, both generic and brand name medications must meet the same standards for safety, purity, and effectiveness-but the generic medication generally costs less. Your doctor or pharmacist can assist you in substituting generic medications when appropriate.
  • Using the mail order prescription drug program. Not only is it more convenient because your prescription is delivered right to your home, but you and the Plan save money because prescription medications are provided at discounted prices through the mail order program.
  • Reviewing your medical bills to ensure that they are accurate. If something does not seem right, or if you are charged for a procedure or supply you never received, question the bill.

Benefit Claims

Generally, you do not need to file claims for medical, prescription drug, dental, or vision benefits; providers file claims for you. Be sure to show the appropriate ID card for the services received to ensure that your provider knows where to file the claim.

In the event of an accident, you should apply for weekly income benefits or accidental dismemberment benefits, if eligible. In addition, in the event of your death, your beneficiary should apply for death benefits. For more information about applying for these benefits, contact the Welfare Fund Administrative Office or visit the Fund’s web site (www.neca-ibew.org).

The Plan processes claims as soon as possible. However, if you have not heard anything on a claim after four weeks from the date the claim was submitted, you can check on the status of the claim by calling the Welfare Fund Administrative Office or visiting the Fund’s Web site (www.neca-ibew.org).

To make the most of your benefits, all claims should be submitted as soon as possible. If a claim is submitted more than one year after the date the claim was incurred, the claim will be denied.

Spotlight on Well Child Care Benefits

With the wide range of health care benefits available under the Plan, sometimes it can be hard to remember what is covered and when. To help you get the most out of your benefits, this newsletter will periodically highlight certain benefits.

In this issue our spotlight is on well childcare benefits. Well childcare benefits, which are covered like other covered medical expenses, include routine office visits, inoculations, and other kinds of well childcare. However, to be considered a covered expense under the Plan, well childcare benefits are only available to eligible dependent children for their first 24 months of life, before the child’s second birthday. On and after a child’s second birthday, well childcare benefits are no longer available to that child.

If you are an active participant, refer to page 21 of the 2003 Edition of your SPD for more information.

If Your Spouse has Other Coverage Available

Remember that if your spouse is eligible for other health care coverage through an employer plan, regardless of the cost to your spouse, he/she must take that coverage or he/she will not be covered under the Plan. If your spouse’s employer does not offer health care coverage or if, for some reason, your spouse is not eligible for the coverage offered, you should submit a letter to the Fund Office from the employer to that effect.

Private Insurance Policy. There may be instances where your spouse may prefer to purchase a private insurance policy rather than elect his or her employer’s coverage. In these instances your spouse may elect to purchase private insurance, provided it is comprehensive coverage that is comparable to your spouse’s employer’s coverage. The Fund will then consider this private insurance policy as your spouse’s other coverage and your spouse will continue to be covered under the Plan, with the Fund paying second, after your spouse’s other coverage.

If your spouse has other coverage, either through an employer plan or a private insurance policy, the Fund will pay benefits second, after the other coverage. This provision was implemented in 2003 to hold down the Fund’s health care costs. While this provision is beneficial in helping the Fund hold down health care costs, it is also beneficial for your spouse because your spouse will have coverage through more than one plan.

It is your responsibility to notify the Fund if your spouse has other coverage through an employer or private policy. If the Fund learns that your spouse has other coverage and does not notify the Fund or refuses to take the available coverage, your spouse will no longer be covered under the Fund’s Plan.

If your spouse is eligible for other coverage and does not enroll for that coverage when eligible, your spouse’s coverage under this Plan will end as of the date your spouse is eligible for such other coverage. In addition, benefits will be backdated to the date on which your spouse could have attained such other coverage. For example, if your spouse becomes eligible for, but does not elect, coverage through his or her employer on January 1st, the Plan will not cover any of you spouses expenses incurred on and after January 1st. If the Fund is not aware that your spouse had other coverage available until April 1st, your spouse’s coverage will still be considered to have ended as of January 1st not April 1st. So, any expenses incurred between January 1st and April 1st will not be covered under the Plan. To avoid any problems that this may cause, your spouse should enroll for any available medical coverage offered by his or her employer.

Women’s Health and Cancer Rights Act Annual Notice

The Plan, as required by the Women’s Health and Cancer Rights Act of 1998, provides medical and surgical benefits for mastectomy-related services, including reconstruction and surgery to achieve symmetry between the breasts, prostheses, and complications resulting from a mastectomy (including lymph edema). These benefits are subject to the Plan’s deductible and coinsurance provisions.

Keep Your Fund Records Up-To-Date

Return your enrollment card to the Welfare Fund Administrative Office as soon as possible. Recently, you should have received an enrollment card. Completion of an enrollment card is required once each calendar year. The Welfare Fund Administrative Office relies on the information on these cards to ensure that claims are paid accurately and promptly. Be sure to complete all information on the enrollment card and return it to the Welfare Fund Administrative Office as soon as possible. Payment of your benefits will be delayed until the Welfare Fund Administrative Office receives your updated enrollment card.

Be sure to update your dependent’s information and your address. If you move during the year, be sure to notify the Welfare Fund Administrative Fund Office as soon as possible. Your current address must be on file to ensure that you receive information about your benefits.

Review your beneficiary designation information. In the event of your death, any welfare or pension death benefits will be paid to the beneficiary on file with the Fund (or as otherwise directed by a court action, such as a QDRO). So, it is a good idea to periodically review your beneficiary designation information and update it as necessary to ensure benefits are paid to the beneficiary of your choice. If you need to update this information, contact the Welfare Fund Administrative Office.

For Your Protection

BlueCross BlueShield (BCBS), our medical network provider, recently issued new ID cards to all Fund participants. The new ID cards have an alternate ID number (randomly assigned), other than your Social Security Number, to ensure that your Social Security Number remains confidential. Be sure to replace your existing ID card (with your Social Security Number) with your new ID card (with the alternate ID number). If you are a retiree over age 65 and eligible for insured coverage under the Monumental Insurance Company program, you may also have been issued a new BCBS ID card. This new BCBS ID card is for your spouse if your spouse is eligible for coverage under the Fund but is not yet eligible for Medicare coverage.

All telephone conversations with the Welfare Fund Administrative Office are recorded. This is done to protect you and the Fund and to ensure that the Fund Office Staff has a record of all important conversations with Plan participants. So do not be alarmed when you call the Fund Office and are informed that your conversation is being recorded.

This Newsletter contains only highlights of certain features of the NECA-IBEW Welfare Trust Fund. Full details are contained in the documents that establish the Plan provisions. If there is a discrepancy between the wording here and the documents that establish the Plan, the document language will govern. The Trustees reserve the right to amend, modify, or terminate the Plan at any time.