Eligibility & Hour Bank

Overview

Eligibility requirements are different depending on whether you are covered under Plan A, Plan B, Plan R or the Flat Rate plan.

Summary Plan Description

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Dependents

Overview

If you elect coverage for yourself, you are also eligible for medical, dental and vision coverage for your eligible Dependents on the later of the day you become eligible for your own coverage or the day you acquire an eligible Dependent, either by marriage, birth, adoption or placement for adoption, but only if you have submitted a completed written enrollment form that may be obtained from the Trust Fund Office and provided the Plan’s required proof of Dependent status is received by the Trust Fund Office.

A Dependent may not be enrolled for coverage unless the Participant is also enrolled. Specific documentation to substantiate Dependent status will be required by the Plan. An eligible Dependent includes your lawful spouse or Qualified Domestic Partner, and your Dependent children.

Enrollment Form  Summary Plan Description

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Medical

Carpenters Health and Welfare Trust Fund carrier options under the medical plan include Kaiser HMO coverage or the Indemnity PPO plan.

Benefits through the Kaiser HMO network require all covered services be provided, or referred by, Kaiser. To elect Kaiser, you must live within their service area.  The Indemnity Medical plan is a Preferred Provider Plan (PPO) that provides self-funded medical benefits to Participants.  The PPO network is arranged through Anthem Blue Cross.  Participants maximize their benefits by using Anthem PPO providers.

Summary Plan Description (Active Plans A, B, R, and Flat Rate)

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Dental

Overview

Dental Benefits are available to Participants and eligible Dependents of Plan A, B, R and the Flat Rate Plan, whether enrolled in the Indemnity Medical Plan or the Kaiser HMO Plan. Dental benefits are administered by Delta Dental of California.

Your dental benefits are structured to provide an incentive to use dentists that belong to the Delta Dental Preferred Provider (PPO) network. You are free to use any licensed dentist but your out-of-pocket costs will be lower if you choose a Delta Dental PPO dentist.

To find a Delta PPO dentist, call Delta Dental at (800) 765-6003 or visit www.deltadentalins.com.

Find a Network Dentist

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Vision Benefits

Overview

Vision coverage is available to all Participants and eligible Dependents.  Kaiser enrollees have benefits with Kaiser's Optometry Department.  Participants and Dependents covered under the Indemnity Medical Plan have vision coverage through Vision Service Plan (VSP).

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Prescription Drugs

The prescription drug benefits described below are only for Participants and Eligible Dependents who are enrolled in the Indemnity Medical Plan. These benefits do not apply to Kaiser members.

The Prescription Drug Plan is managed by the Fund’s Pharmacy Benefit Manager (PBM). The PBM uses a variety of tools to provide safe access to approved prescription drugs. In addition to an approved list of drugs, known as a formulary, the PBM employs other edits which may include, but not be limited to: Prior Authorization for certain therapies, step therapy edits that require the use of tried and proven prescription drugs prior to the approval of newer more costly drugs, frequency and dosing limits, retail refill allowance that channels participants into the mail order delivery method, and Genetic and/or Efficacy testing. Prescriptions submitted that do not comply with PBM rules will be denied. Additionally, the PBM actively monitors for fraud, waste, and abuse which does occur, and intervenes to case manage such events.

The Plan provides a retail pharmacy program and a mail order option for your prescription drug needs. When you need a medication for a short time – an antibiotic, for example – it is best to choose the retail pharmacy program. If you are taking a medication on a long-term basis, it is usually less costly and more convenient to have it filled through the mail order program.

Summary Plan Description

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Member Assistance Program

Overview

Benefits are provided by Anthem Blue Cross of California and this benefit is available to you and your eligible dependents whether you are enrolled in the Indemnity medical program or the Kaiser medical program.

The Anthem Member Assistance Program (MAP) provides solutions to help you balance work and life through confidential and easily accessible services. Anthem MAP puts convenient resources within your reach, and that helps you – and your household members – stay healthy, free of charge.

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Disability

Disability Extension Benefit

If you become temporarily Disabled while covered under Plan A you may qualify for up to 9 months of extended eligibility within a 24-month period. Eligible Participants in Plan R and Plan B may qualify for up to 4 months of extension of eligibility. Flat Rate Participants and Stakeholders are not eligible for this extension of eligibility.

To qualify for a Disability Extension, you must file an application with the Trust Fund Office no later than 12 months from the First Day of Disability.

If your application is approved, a Disability Extension may then be given to extend existing eligibility (up to a maximum of 4 months for Plan R and Plan B or 9 months for Plan A) but not to establish eligibility.

The "lag month" applies. Therefore, in order to qualify for the disability extension, you must have eligibility for the month in which you become Disabled and for the following month.

For example, if you are eligible in April and disabled in April and you have at least 100 hours remaining in your Hour Bank to be deducted for May coverage, you may receive the Disability Extension to extend your Hour Bank for an additional month (for June coverage). However, if there are less than 100 hours in your Hour Bank and you would not be eligible for May, no Disability Extension would be granted.

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