Frequently
Asked Questions - Health and Welfare
What is the
medical deductible per year for an individual and for the family?
Is there a deductible
for Dental and Vision Benefits?
How often can
I get glasses or contacts?
Is there a deductible
on our Prescription Drug Plan with Medco?
Is there a deductible
with Monumental?
Who are the PPO
Providers being used by the Fund and what are their telephone numbers?
Why is my maintenance
drug being rejected at the retail pharmacy?
Why
do I have to fill out a Participant’s Data/Claim Statement
and how often do I have to fill it out?
What information
is accepted for a Student School Letter for continued eligibility
past age 19?
How often do I
have to send a Student School Letter?
When I am receiving
Weekly Income Benefits due to disability, do I have to complete the
weekly letter each week?
How
often do I need to have a physician’s statement completed by
my doctor?
Do I have to pay
taxes on the Weekly Income Benefits?
Why do I need
to complete a Basic Data Card?
How do I add someone
to my coverage?
I will be retiring
soon, what do I need to do?
Do I have to be
a certain age to Retire?
How long do
I have to submit my retiree application?
If I am on
the Retiree Plan and return to work, what will happen?
If I return
to work, will I have dental and vision coverage?
When I become eligible for Medicare, do I have to purchase Medicare
Part B?
When I become eligible for Medicare, will I still have prescription
coverage?
When I am eligible for Medicare, do I have to take the Monumental
coverage if
I wish to continue my participation in the Retiree Plan?
How does it
work when I am Medicare eligible and over age 65 but my spouse
is not Medicare eligible?
 | Top
of Page |
What
is the medical deductible per year for an individual and
for the family?
As of June 1,
2003, the medical deductible for an individual is $500 and $1500
per family each calendar year.
| Top
of Page |
Is
there a deductible for Dental and Vision Benefits?
No deductible has to be met prior to receiving Vision and Dental
Benefits. Please keep in mind there is a dental maximum benefit per
calendar year of $1250.
| Top
of Page |
How
often can I get glasses or contacts?
You can spend up to $300 per calendar year on covered vision services.
| Top
of Page |
Is
there a deductible on our Prescription Drug Plan with Medco?
Yes, a
$50 deductible has to be met each calendar year. Inquiries about
RX deductibles should be referred to Medco at 1-800-711-0917.
| Top
of Page |
Is
there a deductible with Monumental?
No. Any
inquiries about benefits received from Monumental should be made
by contacting the Monumental Benefit Line at 1-800-752-9797.
| Top
of Page |
Who
are the PPO Providers being used by the Fund and what are their
telephone numbers?
- Blue Cross/
Blue Shield for medical at 1-800-810-2583
- Guardian
for dental at 1-888-600-9200
- Medco
for prescriptions at 1-800-711-0917
| Top
of Page |
Why
is my maintenance drug being rejected at the retail pharmacy?
Our plan only allows one (1) fill and two (2) refills at the retail
pharmacy when using maintenance type drugs. Then the prescriptions
will have to be filled by using the mail order provisions with Medco.
You will receive a 90-day supply and the co-pay is $20 dollars for
generic and $30 for brand. If a generic is available and you choose
the brand then you will have a $30 co-pay plus the difference in
cost between generic and brand.
| Top
of Page |
Why
do I have to fill out a Participant’s Data/Claim Statement
and how often do I have to fill it out?
To
receive benefits from the NECA-IBEW Health and Welfare Trust Fund,
you are required
to
fill out a Participant’s Data/Claim
Statement (one per calendar year) preferably at the beginning of
each calendar year so your benefits won’t be delayed while
waiting on you to complete the card. This card is sent to you on
an annual basis. The Fund uses the information on the card to update
any changes on you, your spouse and your dependents that might have
taken place since you last completed a card. Be sure and notify the
Fund Office if your spouse changes employers or has a change in status
with his/her employer in regards to being offered medical insurance.
| Top
of Page |
What
information is accepted for a Student School Letter for continued
eligibility past age 19?
We will accept a letter or fax from the Office of the Registrar
containing the name of the student, the semester enrolled and verifying
Full Time Status.
| Top
of Page |
How
often do I have to send a Student School Letter?
A Student School Letter is required for each semester. The Spring
Semester Letter covers the period from Jan. 1st through May 31st.
The Fall Semester Letter covers the period from June 1st through
Dec. 31st. To be covered for the summer months a full time student
must have been eligible with the plan for the spring semester and
have proof of pre-registration as a full time student for the fall
semester.
| Top
of Page |
When I am receiving Weekly Income Benefits due to disability, do
I have to complete the weekly letter each week?
Yes. Benefits will not be paid unless you fill out the weekly letter.
This letter is used to determine if you are still disabled and to
show when you have recovered.
| Top
of Page |
How
often do I need to have a physician’s statement completed
by my doctor?
Every
six to eight weeks unless your physician states on the form that
you are “permanently and totally disabled”.
| Top
of Page |
Do
I have to pay taxes on the Weekly Income Benefits?
Yes, Weekly Income Benefits are considered income. Tax statements
will be mailed out at the beginning of each year showing the total
amount of benefits you received the previous year.
| Top
of Page |
Why
do I need to complete a Basic Data Card?
In the event of your death, the individual you last named on your
basic data card will be who your death benefits (if eligible) are
paid. It is important to complete a new basic data card as you have
changes in your life such as marriage, divorce and dependents. Your
spouse is automatically your beneficiary unless he/she has consented
otherwise in writing.
| Top
of Page |
How
do I add someone to my coverage?
The best thing to do is to call customer service and tell us who
you want to add to your coverage. We will ask for such things as
birth certificates, divorce decrees, proof of spousal insurance,
child affidavits and school letters depending on your particular
situation.
| Top
of Page |
I
will be retiring soon, what do I need to do?
The Retiree Plan is NOT automatic, so you will need to submit an
application to our office. YOU MAY WANT TO VERIFY YOUR WORK HISTORY
PRIOR TO APPLYING TO SEE IF YOU QUALIFY UNDER THE 45 OF 60 RULE BECAUSE
ONCE AN APPLICATION HAS BEEN RECEIVED, IT CANNOT BE WITHDRAWN.
There are several other requirements that have to be met to qualify
for the Retiree Plan, please contact the Fund Office for a complete
listing.
| Top
of Page |
Do
I have to be a certain age to Retire?
If you are disabled with a Social Security Award, there is no minimum
age requirement.
If you are NOT disabled, you must be at least 55 years of age AND
have an award of retirement from Social Security, NEBF or any other
pension fund in which Union Trustees are selected by one or more
Local Unions affiliated with the IBEW.
| Top
of Page |
How
long do I have to submit my retiree application?
The application must be submitted to our office within 90 days of
your retirement but will not be accepted more than 90 days prior
to your retirement date. However, the application MUST be received
in the Fund Office within 90 days of the last day worked, 90 days
from the run out of bank hours or 90 days from the date you receive
your first proof of award.
If you are applying due to disability, we recommend that you make
application to the Retiree Plan at the same time you make application
for Social Security Disability.
There are several other requirements that have to be met to qualify
for the Retiree Plan, please contact the Fund Office for a complete
listing.
| Top
of Page |
If
I am on the Retiree Plan and return to work, what will happen?
It is very important that you notify the Fund Office when you return
to work and when you cease working. Please keep in mind that when
you return to work you will need to continue your retiree payments
until you have worked 420 hours within a 6 month period and when
you work less than the required 140 per month after you have regained
initial eligibility.
| Top
of Page |
If
I return to work, will I have dental and vision coverage?
You will have dental and vision coverage ONLY the months that you
are eligible due to hours worked.
| Top
of Page |
When
I become eligible for Medicare, do I have to purchase Medicare
Part B?
Yes, you need to enroll in BOTH Medicare Part A and Part B. Monumental
requires you to have both Part A and Part B.
| Top
of Page |
When I become eligible for Medicare, will I still have prescription
coverage?
Yes, your prescription coverage through the Fund with Medco does not change.
| Top
of Page |
When
I am eligible for Medicare, do I have to take the Monumental
coverage if I wish
to continue my participation in the Retiree
Plan?
- Yes, if you are Medicare eligible AND are age 65 or older.
- No, if you are Medicare eligible AND less than age 65.
| Top
of Page |
How
does it work when I am Medicare eligible and over age 65 but
my spouse is not Medicare eligible?
Your benefits will be with Monumental and your spouse will still
receive his/her benefits through the regular plan of benefits till
such time that he/she becomes Medicare eligible and 65 or older.
Just the opposite is true when the spouse is Medicare eligible and
over age 65 and the participant is less than age 65 and not eligible
for Medicare.
If you are Medicare eligible due to disability and less than age
65, Medicare will be your primary insurance and you will send your
bills and EOBs directly to the Fund Office. If your spouse is less
than 65 and not Medicare eligible, he/she will receive benefits under
the regular plan of benefits.
|
