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Health FAQ

• When and how do I become eligible for coverage?
  You become eligible for coverage the first day of the second month following the month in which 360 hours have been reported and paid into your reserve account. These hours must be worked within three consecutive months. Eligibility is on a “skip month” basis. For example, if you worked a total of 360 hours in February, March and April, and these hours were reported and paid for by your employer in May, your eligibility would begin in June.
   
• Once I am eligible, how long will I be covered?
  You will be covered so long as the hours reported and paid in by your employer each month total at least 120. As stated above, eligibility utilizes the “skip month” method. For example, hours worked in May would be reported and paid in June; these hours would provide your coverage in July.
   
• How does my reserve account work?
  Hours are reported and paid in by your employer following the month in which they were worked. As stated above, you need to work 120 hours in the work month to be eligible in the coverage month. Any hours in excess of 120 are placed into your reserve account. If in a month, you have fewer than 120 hours reported, you can use any hours in your reserve account to make up the difference.
   
• Is there a limit to the number of hours that I can have in my reserve account?
  Yes. The maximum number of hours that you can have in your reserve account is 360.
   
• What are my coverage plan options?
  For medical coverage, you have a choice of three plans: a self-funded PPO plan, Kaiser or PacifiCare. The dental plan is also self-funded, and vision benefits are provided through Vision Service Plan.
   
• Which plan is better?
  All plans are excellent. You should carefully study the comparisons to determine which plan would suit you and your family best. With the PPO plan, you can visit any medical provider. You will pay less out-of-pocket if you use PPO providers. The Kaiser Plan requires all services to be obtained at Kaiser facilities with Kaiser’s practitioners. PacifiCare is an HMO that contracts with providers. All care must be coordinated through the PacifiCare primary care physician that you choose. Family members may choose different primary care physicians.
   
• Does my plan have chiropractic/specialist coverage?
  Yes. Please refer to your summary plan description for details.
   
• How do I enroll in my chosen plans?
  To ensure that you and your dependents are covered in the NCTI plan, you must complete the enrollment form that is sent to you by Alllied Administrators when you first become eligible for coverage. If you wish to enroll in one of the HMO’s, contact Allied. We will send you an application which must also be completed in order to enroll in the HMO.
   
• How do I add or delete dependents on my health plans?
  You can add or delete a dependent by printing and completing an Add/Delete form and mailing it to Allied Administrators. Please read the form carefully, as you are required to submit the appropriate documentation, i.e., birth or marriage certificate, divorce decree, etc. If you prefer, you can also contact Allied directly for this form. If you are enrolled in an HMO plan and wish to add or delete a dependent, you must also complete the appropriate form for your HMO.
   
• My child has reached the limiting age, but he is completely dependent on me for support due to a physical limitation. Is there a way I can extend his coverage?
  Yes.  If you have a dependent child with a mental or physical limitation, you can continue his coverage provided that the following requirements are met: your child is chiefly dependent on you for support; your child is not capable of self-sustaining employment; and you give us proof of the child’s handicap: (1) not later than 31 days after the child attains the limiting age; and (2) thereafter as the Trustees may require, but not more than once every two years, by completing a Request for Continued Coverage for Incapacitated Child form.
   
• How/when can I change plans?
  The Plan conducts an annual open enrollment. During this open enrollment period, you will have the opportunity to change your medical plan, if you wish. You will be notified by Allied Administrators when the open enrollment period begins.
   
• How do I file a claim for reimbursement?
  You’ll need to fill out a Claim Form. Be sure to complete all sections and attach appropriate documentation. Then, submit the form to Allied Administrators for reimbursement. You can also contact Allied directly for a claims form.
   
• Is it possible for my physician to submit claims to Allied Administrators electronically?
  Yes! If your physician’s office is set up for electronic filing, simply provide Allied’s EDI number: 94177. That’s all the information they’ll need to file claims electronically.
   
• I need to see a Doctor, but I don't know who to go to. Do you have a list of doctors near where I live or work?
  If you are in the PPO plan, you can get a list of providers close to you at the Blue Cross Prudent Buyer website. Kaiser participants can obtain information on providers at www.kaiserpermanente.org. And, PacifiCare participants should visit the PacifiCare website, www.pacificare.com, to locate PacifiCare-contracted providers that are close to them.
   
• I need to fill my prescriptions – what pharmacy can I use?
  If you are in the self-funded PPO, you can use any of the hundreds of pharmacies that are contracted with Sav-Rx, the PPO plan’s pharmacy benefits manager. Visit their website at www.savrx.com for a listing of pharmacies in your area. Kaiser participants must have their prescriptions filled at Kaiser pharmacies. If you are a PacifiCare participant, your prescriptions must be filled at a pharmacy that contracts with PacifiCare.
   
• I tried to pick up my prescription but the pharmacy told me that I need “prior-authorization.” What should I do?
  Certain prescriptions require prior authorization from the health plan in which you are enrolled. If you are covered by the self-funded Plan with SavRx your pharmacist will let you know if a prescription needs prior authorization. Most pharmacies will work this through directly with SavRx and your doctor’s office. If this is not the case your physician‘s office simply needs to get in touch with the help desk at SavRx (800-228-3108) or contact Allied Administrators.
   
• Do I need an ID card for medical and dental?
  If you are in the self-funded PPO plan and visit a provider who is in the Blue Cross Prudent Buyer Network, you do need to bring your Blue Cross PPO card to your medical appointment. HMO participants have ID’s that are issued by the HMO in which they are enrolled. These must be used for all medical appointments. There are no ID cards for dental benefits, simply provide your dental office with Allied’s phone number, (415) 986-6276, to verify your eligibility and benefits.
   
• Does the dental plan have a PPO? 
  No. You can visit any dentist you wish.  
   
• Is there a claim form specifically for dental claims?
  There is a Dental Claim Form, which you can bring with you to your next dental appointment.  Your dentist can also utilize electronic filing.  Simply give your dentist's office Allied's EDI number:  94177.
   
• I went to my doctor’s appointment today, but I was told that my coverage is terminated. I've been working steadily. Am I covered for the visit?
  If there’s ever a question regarding your eligibility, contact Allied Administrators. We’re here to help you sort it out.
   
• I received a COBRA/Termination letter. Why did I get this notice and what do I need to do?
  You received this notice because you had a COBRA Qualifying Event. The most common reason for this is the combination of current hours worked and the hours in your reserve account was less than 120 hours. Other COBRA Qualifying Events include divorce, death of the participant, or a dependent child’s reaching the maximum age limit. In each of these instances, you will have lost eligibility. If you wish to sign up for COBRA coverage, you must return the application to Allied Administrators within 60 days of the date of your Qualifying Event.
   
• What is the self-pay benefit I’ve been hearing about? Is it the same as COBRA?
  The self-pay benefit is available to active participants who are on the out-of-work list at the union local. The self-payment required is less than the COBRA payment, and there is a maximum number of months in which you can have subsidized self-pay coverage. There are additional requirements to qualify for this period of subsidized self-pay coverage. To see if you are eligible for self-pay coverage, you can contact Allied Administrators.
   
• I'm on disability/worker's comp or FMLA. How do I continue my coverage?
  The Trust offers disability coverage for a specified duration. You should contact Allied Administrators for more information. After the period of disability coverage provided by the Trust at no cost to the member, you can also elect to take COBRA coverage. FMLA coverage is through your employer only, and you must contact your employer to determine what steps you need to take.