We included a Summary of Material Modifications (SMM) to the Welfare Plan with your recent mailing of your quarterly statement. The changes outlined in the SMM became effective June 1, 2011 and you will want to review the content of the SMM and apprise yourself of the changes that were made necessary so that we could comply with new health care reform laws (Affordable Care Act) enacted by our Congress. These changes to your health benefits represent important changes to your Plan. This particular notice applies mainly to our Fee-For-Service PPO Plan. A separate notice will be mailed regarding any changes to the HMO Plan.
If you have any questions, you should contact the Trust Office at 1.800.5274613 for clarification.
FOR FIRST HEALTH Participants:
First Health - Online Directories
First Health will no longer be providing hard copy directories. Unfortunately, they have found that in this changing health environment. the changes can't keep up with the printer and members, in some cases, were getting out-of-date information from the directories. The most accurate listing of contracted First Health providers can be accessed by using their "Online Directory". Below is a link to access the instructions for finding a contracted provider......let your fingers do the walking.
TO GET STARTED: Go to www.firsthealth.com Click: "Create a Directory"
Once you have found a provider, take that extra step and call First Health at 1.800.226.5116 and verify that the provider is still contracted. Information changes daily and we don't want you to incur any added expense as a result of out-of-date information.
QUESTIONS? Call the Trust Office at 1.800.527.4613
SPECIAL NOTICE FOR ACTIVE MEMBERS ONLY REGARDING DEPENDENT COVERAGE FOR CHILDREN UP TO AGE 26
Effective June 1, 2011, the California Ironworkers Field Welfare Plan (“the Plan”) is changing its eligibility rules to extend dependent coverage for children up to the end of the calendar month in which the child attains age 26, regardless of the child’s residence, student status, marital status, or financial dependency.The federal “Patient Protection and Affordable Care Act” requires this change.
Children whose coverage under the Fund ended, or who were denied coverage (or were not eligible for coverage), because availability of dependent coverage of children ended before attainment of age 26 are now eligible to enroll in the Plan effective June 1, 2011. The child’s parent must be enrolled in the Plan, or be eligible and enroll with the child, and the child must be younger than age 26 on June 1, 2011.
Your child may be enrolled for dependent coverage effective June 1, 2011 as long as he or she is under age 26 on that date. Please follow the instructions below to enroll your child. For coverage to be effective June 1, 2011, you must return the enrollment form no later than May 16, 2011. If your enrollment form is received after May 16, 2011, your child will not be eligible until the first of the month following receipt at the Trust Fund Office of your completed enrollment form. Children under age 26 as of June 1, 2011 who are in a COBRA election period or are receiving COBRA coverage from the Plan have the right to cease COBRA coverage and enroll in dependent coverage. Another COBRA election will be available to the child when he or she turns 26.
A child’s spouse and children do not qualify for coverage under the Plan.
Children cannot be enrolled in a different medical option than the option you elect for yourself. However, a change of medical plans may be made if the child is enrolled no later than May 16, 2011.
Attached is a Special Enrollment Form for Children Under 26.Please complete this form and attach a copy of your child’s certified and recorded birth certificate or adoption paperwork. Return the form and attachments to the Trust Fund Office within thirty (30) days from the date of this Notice. The Trust Fund Office will only be able to process completed forms with the required documentation.Coverage for children will commence June 1, 2011 through the end of the calendar month in which the child attains age 26.
Please note: if you are a retired participant and choose to enroll children under age 26 there will be an additional charge of $165 per dependent per month added to your monthly health and welfare premium deductions. If you have any questions or require additional information regarding this benefit implementation, please do not hesitate to contact the Trust Fund Office. If this benefit applies to your family - the Trust Fund Office will send you the required application.
On the links below, you will find a summary of information on the health and welfare plans offered to active and retired members and their dependents. This includes the most frequent asked questions and answers for the fee-for-service plan. If you need additional information please contact the trust office by calling 1-800-527-4613 or 1-626-792-7337. For information on HMO's see Related Sites Page.
California Ironworkers Field Welfare Plan Ironworkers Fee For Service Dental Plan New Preferred Provider Network Effective January 1, 2011
Beginning January 1, 2011, Delta Dental replaced United Concordia as the new preferred provider network for the Ironworkers Fee For Service Dental Plan for both Active and Retired participants.Delta Dental will be able to provide us with a larger network of providers, as well as an additional tier of benefits for our membership.
In late December, you should have received new identification cards from Delta Dental to be used beginning January 1, 2011.Below is a brief summary of the new benefits under this Plan:
Benefit Description Fee-For-Service PPO Dental Plan Contract Provider Benefits
Calendar Year Deductible $50 per person $150.00 Family Maximum
Maximum Calendar Year Benefit $3,000 per person / Delta Dental PPO Dentist $2,000 per person / Delta Premier PPO Dentist $1,500 per person / Out-of-Network
Diagnostic and Preventative Delta Dental PPO Dentist Delta Dental will pay 100% of their fee schedule and there will be no further patient responsibility. Delta Dental Premier PPO Dentist Delta Dental will pay 100% of their fee schedulefor diagnostic and preventative care; 80% of their fee schedule for basic services, crowns, cast restorations and prosthodontics.
For out-of-network providers, the plan will pay at 80% of the Delta Dental fee schedule for diagnostic and preventative treatment; however, the patient can be billed the difference between the fee schedule allowable amount and the actual amount billed.
All other out of network services will be paid at only 50% of the Delta Dental fee schedule. OrthodontiaPlan pays 50% of Delta Dental Fee Schedule up to a lifetime maximum benefit of $1,000. Prior authorization is required and coverage is only provided for dependent children to age 21 only.
If you have specific benefit questions relating to claims payment, please feel free to contact Delta Dental directly at (800) 765-6003.For provider information please refer to their website www.deltadentalins.com.As always, please do not hesitate to contact the Trust Fund Office with any additional benefit questions.
Important Numbers
Fee-For-Service Eligibility Verification Available 24 Hours (866) 983-4353
Benefit Information Center (800) 527-4613
Medical Providers Health Net Medical Southern California (800) 522-0088 Northern California (800) 638-3889 Spanish (800) 331-1777 Health Plan of Nevada (800) 777-1840 Kaiser Northern and Southern California 800) 464-4000 Pacificare of California (800) 624-8822 Pacificare of Arizona and Nevada (800) 347-8600 Managed Health Network (800) 977-7962 Secure Horizons Direct (866) 525-6437 EnvisionRx Options (800) 361-4542 Dental Providers Assurant Employee Benefits (800) 443-2995 Health Net Dental (800) 880-8113
United Concordia HMO (866) 357-3304 PPO/FFS (800) 332-0366 DeltaCare, USA (800) 422-4234 Vision Providers
Vision Service Plan (VSP) (800) 852-7600 or (800) 877-7145 Spectera Vision Plan (800) 839-3242
Please contact our office via email or by calling 1-800-527-4613 if you have any further questions or comments.
