FREQUENTLY ASKED QUESTIONS

General

Vacation

Health and Welfare

MOE Pharmacy Questions

Pension Fund

General

What do I do if a contractor does not pay contributions on my hours or if the hours are not correct?

Send in copies of your check stubs to the Fund Office, Attn: Accounts Receivable. We will review the check stubs and the company will be contacted for any hours due on your behalf.

I moved, why do I need to send you a special form for the address change?

The Fund Office requires your signature on any change of address request, to allow the Fund to make this change. This is for your protection, and only you can authorize this change. In addition, you will also need to notify your Union Office and/or the Credit Union as the Fund Office does not share this information. Please note that if you change your address with your Union Office and/or the Credit Union, you must still complete and submit a change of address form to the Fund Office.

Vacation

Since the company did not pay my vacation pay on time, when will I receive the money?

The Plan year for the Vacation Plan is from December 1 through November 30; to be paid in the following January. If contributions are received after December 31 for work months before December, you will receive the vacation money the month after the money is posted.

Health and Welfare

Where do I mail in my claims?

If you are an active member and using BlueCrossBlueShield PPO network providers, the providers will submit claims for you and there is nothing you need to do. All other claims, including all Medicare and dental claims, should be mailed directly to the Fund Office. If you have received a second notice from your provider of service, please contact the Fund Office.

How do I find a network doctor or hospital? How do I know if my doctor or hospital is in the network?

Contact your network at the number listed below:

What is a deductible?

Each year, before the Plan begins to pay for most covered expenses, you or your family pay the first dollars of eligible expenses. This is the deductible, which is stated per person, with a family maximum. The deductible is payable to the doctor or hospital where the charges were incurred. The Explanation of Benefits (EOB) you receive on the charges you submit will show the amount you owe.

What is a copay and who do I pay it to?

After satisfying the deductible, you and the Plan share responsibility for eligible medical expenses; this is known as copayment. For Plan A, the Plan pays 90% for PPO network expenses or 80% for non-PPO network expenses. You pay the remaining 10% for PPO network or 20% for non-PPO network expenses, which are within the Fund’s reasonable and customary guidelines, to the doctor or hospital where the services were performed.

What is the difference between network and non-network?

A Preferred Provider Organization (PPO) is a network of providers (known as in-network providers) that have been contracted to provide services at discounted rates. The discounted rates and the associated savings are the biggest difference between in-network and out-of-network providers. The Fund shares any network savings with you by reducing the amount that you owe for the services performed by in-network providers. In addition, for out-of-network providers, you are responsbile for paying any amounts over the Plan's reasonable and customary guidelines.

Are my benefits limited?

Once your payments toward the deductible and copayments for eligible medical charges reach the annual out-of-pocket maximum of $2,500 per person ($6,000 per family), the Plan will usually pay 100% of most eligible expenses for the rest of the calendar year. Expenses not covered under the Plan do not apply toward the out-of-pocket maximum. In addition, some expenses are never paid at 100%.

What is the annual and/or lifetime maximum?

The Plan pays medical benefits up to an annual maximum $50,000 per person in a calendar year. In addition to the annual maximum, each eligible individual also has a nonrenewable Supplemental Lifetime Fund maximum. This is a lifetime amount that is available to supplement amounts that exceed the annual maximum.

What is a dental pre-determination and why do I need one?

The Fund Office recommends that you get a dental pre-determination whenever you are having dental work in excess of $250. This will give you an estimate of what the Fund will consider for payment and will help you know in advance just how much you will owe your dentist. This is an estimate of benefits and not a guarantee of coverage.

What do I need to do if I have a mental health or substance abuse issue?

You must contact the Plan's confidential provider, ComPsych, at 888.327.4315. They will walk you through the process and refer you to an appropriate provider of service. Everything discussed in this phone conversation is kept highly confidential between you and the ComPsych representative.

I moved, why do I need to send you a special form for the address change?

The Fund Office requires your signature on the change of address request, allowing the Fund to make these changes. This is for your protection, and only you can authorize this change. In addition, you also need to notify the union office and Credit Union as the Fund Office does not share this information. Please note that if you change your address with your union office and/or the Credit Union, must still complete and submit a change of address form to the Fund Office.

How do I qualify for the retiree coverage under the Retiree Health and Welfare Plan?

To be eligible for retiree coverage, you must:

• Be eligible for Health and Welfare Plan coverage under the active plan on your retirement date;
• Have at least 10 years of service under in the Pension Plan; and
• Have at least 40 quarters of eligibility in under the Health and Welfare Plan.

Are payments required for retiree coverage under the Retiree Health and Welfare Fund?

Yes. Payment is required before the first month of your retirement. However, if you have a bank of hours to run out for active coverage on your retirement date, payments will begin when you no longer have sufficient hours for active coverage.

Are retiree benefits under the Health and Welfare Plan the same as for active participants?

When you become eligible for retiree coverage, you are no longer eligible for weekly disability, death, or accidental dismemberment benefits. However, all other benefits are the same as Plan A.

If I marry or re-marry after retiring, can I add my new spouse to my retiree coverage under the Health and Welfare Plan?

Yes, but you must submit a copy of your marriage certificate and request a new application for coverage within six months of your marriage date. Coverage will not begin until a payment is made for dependent coverage.

What happens when I become eligible for Medicare?

Your payment for retiree coverage under the Retiree Health and Welfare Plan will be reduced as Medicare will be your primary coverage and the Fund will be secondary. You must submit a copy of your Medicare card to the Fund Office. Click here for information about the affect of Medicare prescription drug coverage on your Plan benefits.

How do I qualify for retiree coverage under the Retiree Health and Welfare Plan?

To be eligible for retiree coverage, you must:

1. Be eligible for Health and Welfare Plan coverage in the active plan on your retirement date;
2. Have at least 10 years of service in the Pension Plan; and
3. Have at least 40 quarters of eligibility in the Health and Welfare Plan.

MOE Pharmacy Questions

Can my physician phone in my prescription?

No, the MOE Pharmacy will only accept a fax of your prescription directly from your physician’s office. However, you can mail your prescriptions to the MOE Pharmacy or drop them off at the MOE Pharmacy window.

What is the number my physician can use to fax in my prescription?

708.354.2642

Why did the pharmacy dispense a brand name medication instead of the generic equivalent?

If a generic medication does not exist or your physician checked the “may not substitute” box on the prescription, by law, the pharmacy must dispense the brand name medication.

Pension Fund

How do I earn a right to a pension benefit?

You earn a right to a pension once you are “vested” in the Plan. In general, you earn one year of vesting service for each Plan year (April 1st through March 31st) in which you work at least 500 hours in covered employment.

How long does it take to be vested for a pension benefit?

You are partially vested after three years of service and 100% vested after seven years, based on the following schedule:

Can I borrow or withdraw my pension from the Fund?

No, the Pension Plan was established as a defined benefit plan to provide you with a monthly pension benefit when you retire. There are no provisions in the Plan for loans or lump sum withdrawals.

What types of Pensions are provided under the Plan?

• Normal Retirement Pension at age 65 (must be at least partially vested)
• Normal Retirement Pension at age 60 ( must be 100% vested with 10 years of vesting service)
• Early Retirement Pension as early as age 55 – 59 (must be 100% vested with 10 years of vesting service)
• Disability Pension

How is my pension benefit calculated?

As of April 1, 2006, this is how a Normal Retirement Pension is calculated:

Example of pension benefit for contributions paid on and after April 1, 2006:
$150,000.00 x 3.0% x 100% = $4,500.00 per month

The Normal Retirement Pension is calculated differently if you left covered employment before April 1, 2000 or if you did not work at least 500 hours in covered employment in either the Plan year that began April 1, 1998 or April 1, 1999.

Depending on the form of payment you elect, you will receive an adjusted monthly benefit.

Is my benefit reduced for early retirement?

Yes, your benefit is reduced by 0.25% per month for each month you are younger than age 60. (Example: Your benefit is reduced by 15% if you retire at age 55).

When should my pension application be submitted?

Your application must be received in the Fund Office before your pension effective date.

When will I get my first pension check?

It may take from 6 to 10 weeks to process your application, but once approved, your initial pension payment will be retroactive to the effective date of your pension.

Can I work after retirement?

If you are at least age 60, you may work up to 40 hours per month in covered employment without suspension of your pension benefit and you must be dispatched by the Union Hall. However, you cannot work any hours in the effective month of your pension. For more information about suspension of benefits, click here (58K, PDF).