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Skip Navigation LinksHome » Health FAQ » Health Faq Retiree  
 

  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  

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

 
www.bcbsil.com (in Illinois) or www.bcbs.com (out-of-state)
 
Express Scripts - Telephone: 1-800-939-20891-800-939-2089
 

5. What are the deductibles and co-insurance under the Retiree Plan of Benefits?
Answer 5:  

  • If the covered individual is NOT yet Medicare eligible, click here to go to the section for information on deductibles and co-insurance. 
  • If the covered individual is Medicare eligible, click here to go to the Medicare Supplement section for information on deductibles and co-insurance.
 
Click here to go to the Prescription section for information on Prescription Drug co-insurance.

6. What are the premiums for Retiree Coverage?
Answer 6: Click here to go to the Premiums section for information.

7. There are separate premiums for Comprehensive Medical Coverage and for Medco Prescription Drug Coverage. Do I have to elect both types of coverage?
Answer 7:  No. You can elect one without the other.

8. How do I find a network provider?
Answer 8:  You can locate a:
 
BCBS PPO (hospital or physician) provider, by calling   1-800-810-25831-800-810-2583 or visiting their website at www.bcbsil.com (in Illinois) or www.bcbs.com (out-of-state).
 
Express Scripts participating pharmacy (prescription drugs), by calling 1-800-939-20891-800-939-2089 or visiting their website at www.expresscripts.com.

9. I understand that the Retiree Plan of Benefits does NOT include the ComPsych Network for mental health & substance abuse. Are these things covered by the Retiree Plan of Benefits?
Answer 9:  Under the Retiree Plan of Benefits, there services are considered under the Comprehensive Major Medical and are subject to PPO & non-PPO deductibles and co-payments.

10. How do I fill a prescription?
Answer 10:  You may take your prescription to any ESI participating retail pharmacy. To locate a retail pharmacy in the ESI network or request a claim form, call 1-800-939-2089800-939-2089 or visit their website at www.expresscripts.com.

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

Long term 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.

11. Does coverage continue for my surviving spouse and/or dependents following my death?
Answer 11:  No. Coverage terminates at the end of the month in which your death occurs. Your surviving spouse and/or dependents will be offered self-pay continuation coverage. Click here to go to the Termination of Coverage Section for more information.

12. If I elect a Joint-and-Survivor payment option for my monthly pension benefit, will my surviving spouse continue on the Retiree Welfare Benefits following my death?
Answer 12:  No. Electing a Joint-and-Survivor payment option for your monthly pension has no impact on termination of coverage following your death. Click here to go to the Termination of Coverage Section for more information.

13. I postponed coverage because of coverage by another plan. That insurance is now ending. How do I add myself, my spouse and/or dependents to the Retiree Plan of Benefits?
Answer 13:  Note that you must enroll in the appropriate retiree benefits(s) the month following the termination of the other insurance.

You should request an enrollment form from the Retirement Benefits Department at least thirty days in advance of the date that you wish to be added to the Retiree Plan of Benefits. All of the require documentation must be received by the Retirement Benefits Department by the 15th of the month prior to the month you wish to be added to the Retiree Plan of Benefits. 
 
You will be required to submit a creditable coverage certificate from the other plan that shows coverage from the date of retirement to the date you want to be added to the retiree benefits.

14. I am planning on marrying. How do I add my new spouse to the Retiree Plan of Benefits?
Answer 14:  Your new spouse will become eligible for coverage on the date of your marriage, provided that you complete an enrollment form and retiree participant information form (which can be obtained by calling the Retirement Benefits Department at 312-787-9455312-787-9455/Option 4) and submit the required documentation (the original county certified marriage document – it will be returned to you)) within ninety (90) days of your marriage. You may postpone coverage for a new spouse only if there is other coverage through another plan. In this situation, enrollment must take place immediately following the termination of the other plan.

15. How do I add a new dependent to the Retiree Plan of Benefits?
Answer 15:  Your new dependent will become eligible for coverage on the date that you acquire the dependent, provided that you complete an enrollment form and a retiree participant information form (which can be obtained by calling the Retirement Benefits Department at 312-787-9455312-787-9455/Option 4) and submit the required documentation (the biological child’s original county certified birth certificate, the original adoption papers or other documentation as needed – original documents will be returned to you) within ninety (90) days of the date you acquire the Dependent. You may postpone coverage for a new dependent only if there is coverage through another plan. In this situation, enrollment must take place immediately following the termination of the other plan.

16. How do I cancel coverage?
Answer 16:  You must complete a cancellation request form. The completed cancellation request form must be submitted to the Retirement Benefits Dept. by the 15th of the month prior to the month you wish to cancel coverage.

17. I am in the process of divorcing; what do I need to do?
Answer 17:  Please contact the Fund Office if you are in the process of a divorce or are legally separated. You must submit a complete copy of the divorce decree immediately following 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. Note that you will be responsible for any claims paid by the Welfare Fund based upon your failure to report your situation.
 
Additionally, if the Fund Office is not notified of your divorce within sixty (60) days, your surviving spouse (and/or dependent(s)) will lose eligibility for continuation coverage under COBRA. Provided that the Fund Office is notified of your divorce within sixty (60) days, your former spouse will have the option to continue coverage under COBRA on a self-pay basis. Continuation coverage under COBRA is the same coverage that your former spouse had prior to your divorce. The Fund Office will send your former spouse a “Notice of Health Care Continuation Procedures” and a COBRA Enrollment Form. Your former spouse has 60 days to complete and return the Enrollment Form to Health Care Service Corporation (HCSC) at the address listed on the Enrollment Form. Provided that your former spouse returns the Enrollment form to HCSC within the 60 day period, continuation coverage under COBRA will begin the first day of the month following your divorce. Please note that the maximum coverage period of continuation coverage under COBRA is 36 months.

18. If I am divorced who covers the children?
Answer 18:  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.

19. Does the Plan cover step-children?
Answer 19:  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.

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

Answer 20:  If your claim for benefits is denied in whole or in part, you have the right to have the initial determination reviewed by appealing the denial to the Trustees of the Appeals Committee.  Your appeal must be submitted in writing within 180 days of the receipt of the denial of your claim.  Written appeals should be mailed to:  Trustees of the Appeals Committee, Chicago Regional Council of Carpenters Welfare Fund, 12 E. Erie Street, Chicago, Illinois 60611.

 

 
 

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