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Skip Navigation LinksHome ยป Health FAQ  
 

1. When do I become eligible for benefits?

2. As an apprentice, when do I become eligible for benefits?

3. What if I don’t have enough hours in a quarter to continue my coverage?

4. What if my reported hours do not match the hours I actually worked?

5. How do I add my spouse or children to the Plan? 

6. How do I add my newborn baby to the Plan?

7. I’m getting a divorce; what do I need to do?

8. How do I get my benefit identification cards?

9. How do I find a provider?

10. Do I need to contact someone if I am in the hospital?

11. Are there any medical deductibles or co-insurance?

12. If I need mental health or substance abuse care, who do I call? 

13. How do I fill a prescription?

14. I had a test performed at the hospital and you paid the bill. Why am I now getting a bill from a physician?

15 Does the Plan pay for health club memberships?

16. How do I file an appeal? 

17. Why does the Plan send injury and accident investigation letters? 

18. How long do I have to file a claim for benefits?

19. Are life insurance benefits available for me and my family? 

20. Will my life insurance coverage remain in effect if I lose eligibility?

21. How do I change my life insurance beneficiary?

22. If I am sick or injured and unable to work, does the Plan provide any type of disability benefits?

23. If my spouse works and also has insurance, who pays first? 

24. If I’m divorced who covers the children? 

25. Does the Plan cover step-children?  

26. What effect will my military service have on my benefits?

27. If my benefits are denied, do I have the right to appeal?


1. When do I become eligible for benefits?
Answer 1:  You will initially become eligible for plan benefits on the first day of the coverage quarter following one but not more than two consecutive calendar quarters during which a total of at least 500 hours of contributions have been paid to the Fund on your behalf by one or more contributing employers. Please see the chart below indicating the calendar quarters and corresponding coverage quarters
.
 

Work Calendar Quarters

Corresponding Coverage Quarters

January 1 – March 31

June 1 – August 31

April 1 – June 30

September 1 – November 30

July 1 – September 30

December 1 – February 28

October 1 – December 31

March 1 – May 31

To maintain eligibility for coverage, you must have contributions of at least 250 hours paid to the Welfare Fund during each calendar quarter. 

Example:
After satisfying initial eligibility, if you receive credit for at least 250 hours (200  hours if currently attending the Apprentice Training School) of contributions reported during the following calendar quarters, you will be eligible for benefits in the following benefit quarters:

Your Work During This Quarter

Results In Eligibility In This Quarter

January 1 through March 31

June 1 through August 31

April 1 through June 30

September 1 through November 30

July 1 through September 30

December 1 through February 28 (or 29)

October 1 through December 31

March 1 through May 31

If you do not receive credit for 250 contribution hours in a calendar quarter but received credit for at least 1000 contribution hours in the current and the three immediately preceding calendar quarters, you will remain eligible for coverage for the next three month coverage quarter.

Example:
After satisfying initial eligibility, if you receive credit for at least 1000 hours (760 hours if currently attending the Apprentice Training School) during the four (4) calendar quarters (12 months), you will be eligible for benefits in the following eligibility quarters:

Calendar Quarters Corresponding Eligibility Quarters
January 1 through December 31 March 1 through May 31

April 1 through March 31

June 1 through August 31

July 1 through June 30

September 1 through November 30

October 1 through September 30

December 1 through February 28 (or 29)

Click here to go to the Enrollment and General Eligibility section for more information. 


2. As an apprentice, when do I become eligible for benefits?
Answer 2:  If you are an apprentice you have special eligibility rules.  You will initially become eligible for benefits on the first day of the coverage quarter following one but not more than two consecutive calendar quarters during which a total of at least 400 hours of contributions have been paid to the Fund on your behalf. Apprentices qualifying under this special “400 Hours” rule will be eligible for all benefits except the prescription drug and dental benefits. 

 

After you meet initial eligibility, you will need at least 200 hours per quarter to maintain eligibility. If you do not receive credit for 200 contribution hours in a calendar quarter but received credit for at least 760 contribution hours in the current and the three immediately preceding calendar quarters, you will remain eligible for coverage for the next three month coverage quarter.

Please refer to the chart in Question 1 above indicating the calendar quarters and corresponding coverage quarters.

If you are an apprentice and a total of at least 500 hours of contributions have been paid to the Fund on your behalf during one but not more than two consecutive calendar quarters, you will initially become eligible for full Plan benefits on the first day of the next coverage quarter. Full Plan benefits include the prescription drug and dental benefits.

Click here to go to the Enrollment and General Eligibility section for more information.


3. What if I don’t have enough hours in a quarter to continue my coverage?
Answer 3:  If you fall short of the required hours to maintain eligibility, you may be given the option to self-pay for continuation coverage under COBRA or the Low Cost Medical Plan in order to maintain eligibility for benefits for that quarter.

 

Click here to go to the Continuation Coverage section for more information.

4. What if my reported hours do not match the hours I actually worked?
Answer 4:  You should first contact your employer(s) to resolve the discrepancy. If you are unable to resolve the discrepancy with your employer(s), please contact the Fund Office at 312-787-9455, and speak with Harold Boswell, ext. 701, Rich Oginski, ext. 277 or Earl Oliver, ext. 281 in the Collections Department. 

5. How do I add my spouse or children to the Plan? 
Answer 5:  If you are getting married, or have children, you must submit an original certified marriage certificate and original certified birth certificates for your dependent children to Participant Services Dept at the Fund Office, along with other required forms. Contact the Participant Services Dept at (312) 787-9455, phone option 3, with additional questions regarding adding dependents or other life changing events (marriage, divorce, birth of a child, adoption).

6. How do I add my newborn baby to the plan?
Answer 6:  We understand it can take a few months to obtain a birth certificate for a newborn child. Keep in mind that if you are eligible for benefits, the Health Benefits Dept. will add your newborn child as a covered dependent under the Plan for up to 90 days from the date of birth while you wait for the original certificate. In order to add a newborn child, you (1) must be the natural parent , (2) provide a copy of the hospital birth record announcement and (3) complete a Participant Information Form from the forms section of this site. Contact the Health Benefits Dept. to receive these forms, or download them from our website at www.crccbenefits.org. An original birth certificate is required to be submitted to the Fund Office to continue coverage beyond 90 days after the newborn's birth. The original document will be returned to you via certified mail.

Click here to go to the Forms page.

7. I’m getting a divorce; what do I need to do?
Answer 7:  Please contact the Health Benefits Dept. if you are in the process of a divorce or are legally separated. You must submit a complete copy of the divorce decree within 60 days from the date of the divorce or legal separation. If you were eligible for benefits, your former spouse’s insurance coverage will terminate at the end of the month in which the divorce is final. Your former spouse is not eligible to remain covered by the plan as your dependent once the divorce is final. COBRA continuation coverage will be offered to your former spouse for a period of 36 months. Failure to notify the Fund within 60 days may forfeit your and your dependents right to COBRA continuation coverage and you will be responsible for any claims paid by the Fund based upon your failure to report your situation.

8. How do I get my benefit identification cards?
Answer 8:  If this is the first time you have met the requirements for eligibility, medical cards (BCBSIL, Express Scripts, Delta Dental and EyeMed) will automatically be sent to you at the address we have on our system. If you change your address, please notify the Participant Services Dept. at the Fund Office at 312-787-9455, phone option 3.

If you need a replacement card, visit the provider’s website and request a replacement card: 


9. How do I find a provider?
Answer 9:  You can locate a:

  • BlueCross BlueShield PPO (hospital or physician) provider, by calling 1-800-810-2583 or visiting their website at www.bcbsil.com.
  • EyeMed Vision Care provider, by calling 1-800-334-7591 or visiting their website at www.eyemedvisioncare.com
  • ComPsych Guidance Resources provider by calling 1-888-860-1566 or visiting their website at www.guidanceresources.com 
  • Health Dynamics facility (Comprehensive Health Evaluation Program) by calling 1-414-443-0200 or visiting their website www.hdhelpsu.com.
  • Express Scripts participating pharmacy (prescription drugs), by calling 1-800-274-1137 or visiting their website at www.expresscripts.com.
  • QualSight Lasik Surgery Network provider, by calling 1-877-507-4448 or visiting their website at www.qualsight.com.
  • Delta Dental – By calling 1-800-323-1743 or visiting their website at www.deltadentalil.com. 

10. Are there any medical deductibles or co-insurance?  
Answer 10:  No, it is not required.

11. Are there any medical deductibles or co-insurance? 
Answer 11:  Yes, under the Comprehensive Medical Benefit plan, the following deductibles and co-insurance apply:


PPO Provider Non-PPO Provider
Calendar Year Deductible
$300/Person
$900/Family (3 or more)
$600/Person $1,800/Family
Co-Insurance for Professional Charges 80% paid by Plan

20% paid by Individual

60% paid by Plan

40% paid by Individual

Click here to go to the Medical section for more information.


12. If I need mental health or substance use disorder care, who do I call? 
Answer 12:  You or a family member should call ComPsych Guidance Resources at 1-888-860-1566 for an authorization before seeking treatment for mental health or substance use disorder whether you are using a ComPsych in-network provider or using an out-of-network provider. There are no benefits available for mental health or substance use disorder through the BCBS PPO Network.

Click here to go to the Behavioral Health section for more information.

13. How do I fill a prescription?
Answer 13:  You may take your prescription to any Express Scripts participating retail pharmacy. To locate a retail pharmacy in the ESI network or get a claim form, call 1-800-939-2089 or visit their website at
www.expresscripts.com .

A maximum number of three (3) fills (purchases) for long term medications may be purchased at Retail pharmacies. Thereafter, all long term medications must be filled through the Mail Order Program. 

Long term or maintenance medications are those prescription medications that are continually taken on a regular basis (e.g., high blood pressure, cholesterol lowering, allergy, etc.). Prescriptions for illnesses that are temporary in nature, such as antibiotics for a respiratory infection or pain relievers, may continue to be purchased at retail, without limitation. 

Click here to go to the Prescription section for more information.

14. I had a test performed at the hospital and you paid the bill. Why am I now getting a bill from a physician?
Answer 14:  The hospital or facility where the test is performed bills for the “test” itself (the use of the equipment). The physician who performs the service or interprets the test will bill separately for their services. You will receive a separate physician bill for services such as cardiology, radiology, including mammograms and x-rays, pathology, anesthesiology and emergency department treatment.


15. Does the Plan pay for health club memberships?
Answer 15:  No, the Plan does not cover health club memberships.


16. How do I file an appeal?
Answer 16:  You must send an appeal in writing to the Health Benefits Dept. at the Fund Office not more than 180 days after the date you receive the denial of the claim. You may download an Appeal Form in the "Forms" section under Health Plan. Your appeal must state (1) the reasons why you disagree with the claim determination, (2) your medical identification number (as found on your BCBS or Express Scripts ID card) or social security number, (3) the claim number and (4) the date of service. Send the Appeal Form and any supporting documentation to: Trustees of the Appeals Committee, Chicago Regional Council of Carpenters Welfare Fund, 12 East Erie Street, Chicago, IL 60611

17. Why does the Plan send injury and accident investigation letters?
Answer 17:  The Plan does not cover services that are work related or where a third party (auto/home owners insurance) may be the responsible payer. If the Plan receives a claim from your doctor or hospital that has a diagnosis that might be related to one of the situations noted above, we must investigate to determine whether it is a claim that should be paid by the Plan. Your claim will be reconsidered when we receive the written response to our request for information.

 18. How long do I have to file a claim for benefits?
Answer 18:  You have 24 months from the date of service to file a claim, but you should file them as soon as possible. You should not wait until the end of the year to submit your claims. Claims older than 24 months will be denied.


19. Are life insurance benefits available for me and my family? 
Answer 19:  If you are eligible for the Active Plan of benefits, the following life insurance benefits apply:

  • Participant: $50,000
  • Spouse:  $2,500
  • Each eligible Dependent: $2,000

 Click here to go to the Life Insurance section for more information.


20. Will my life insurance coverage remain in effect if I lose eligibility?
Answer 20:  No, it will not. However, you can apply to convert to an individual life insurance policy for you or any of your dependents with Aetna Life Insurance Company. Contact the Health Benefits Dept. at the Fund Office at 312-787-9455, phone option 3, to request a Conversion Policy application form. The application and payment must be received by Aetna within 31 days from the date your eligibility terminated.

 

 21. How do I change my life insurance beneficiary?
Answer 21:  The Fund Participant may change a designated life insurance beneficiary at any time. You must contact the Health Benefits Dept. at the Fund Office at 312-787-9455, phone option 3 and request a new enrollment form or download it from the link below. The change in beneficiary will take effect when the Fund Office receives the signed enrollment form. 

Click here to go to the Life Insurance section for more information. 

Click here to download the Life Insurance beneficiary form.


22. If I am sick or injured and unable to work, does the Plan provide any type of disability benefits?
Answer 22:  If you are eligible for the Active Plan of benefits and unable to work as a result of a non-work related illness or injury, you are not retired and you are under the active care of a physician during the entire period of your disability, you may be entitled to a weekly sickness and accident benefit for a maximum of 52 weeks in the amount of $450 per week and you may receive credit of 40 hours of Welfare contributions for each week (based on a seven calendar day period) of disability for a maximum period of 52 weeks.
 

If you are eligible for the Active Plan of benefits and disabled by illness or injury which arises out of the course of employment (work related), you should notify your employer directly so that a workers comp claim can be filed. You may be entitled to receive 40 Welfare credit hours per week (based on a seven calendar day period) while you are disabled for a maximum period of 52 weeks.

You must contact the Health Benefits Dept. at Fund Office at (312) 787-9455, phone option 3, to report a disability.

Click here to go to the Disability section for more information. Relevant forms can be downloaded from the forms section.

23. If my spouse works and also has insurance, who pays first? 
Answer 23:  Coordination of Benefits (COB) rules apply throughout the insurance industry for determining the sequence of payments.  Under these rules, one group plan has “primary” responsibility and pays first. The other plan has “secondary” responsibility and considers any additional benefits. You and your eligible dependents’ coverage will be coordinated so that payments from both plans won’t exceed 100% of the covered expenses for services and supplies.

The following chart shows which plan is designated as primary or secondary in the case of a husband and wife who work for different employers and also have a child eligible for Dependent coverage:

Patient

Primary Plan

Secondary Plan

Employee

Employee’s

Spouse’s

Spouse

Spouse’s

Employee’s

Natural Child

Parent Whose Birthday (Month and Day) Falls First in the Calendar Year*

Parent Whose Birthday (Month and Day) Falls Second in the Calendar Year*

*If both parents have the same birthday, the plan covering the parent for the longer period of time will pay first.

 24. If I’m divorced who covers the children? 
Answer 24:  If the natural parents of a dependent child are divorced or legally separated, the plan of the parent who has responsibility for providing medical insurance as determined by a court decree for that dependent will be the primary plan.  If the court decree does not address this, the birthday rule applies.
 

25. Does the Plan cover step-children?  
Answer 25:  If there is no decree establishing parental responsibility for medical insurance and the parent with custody remarries, the custodial parent's plan remains primary; the step-parent's plan is secondary. The plan of the natural parent without custody is last. Primary coverage for stepchildren is only provided in the event that no other person is obligated to provide insurance and no other insurance is available through the natural parents. Coverage for stepchildren terminates the last day of the month of the divorce or legal separation from the eligible Participant. 


 26. What effect will my military service have on my benefits?
Answer 26:  If you enter active military service the following benefits will be suspended during your military service and will be reinstated upon your return in accordance with the Uniformed Services Employment and Reemployment Reinstatement Rights Act of 1994 (USERRA).

  • Life Insurance Benefits,
  • Accidental Death and Dismemberment Insurance Benefits and
  • Weekly Sickness and Accident Benefits.

Note: A child is not considered an eligible dependent if he/she is in full time military service.

27. If my benefits are denied, do I have the right to appeal?
Answer 27:  If your claim for benefits is denied in whole or in part, you have the right to have the initial determination reviewed. See question 16 for instructions on how to file an appeal.

 

 

 
 

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