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Health Benefit FAQs |
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The following are the most commonly asked questions by
Members regarding the Health & Welfare Plan.
If you would like detailed information on any of these topics, please consult the
Health & Welfare Plan Booklet.
If you still have questions after reading this information,
please contact the Plan Administrator. |
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How can I tell if I'm covered by the Plan?
To ensure that you are indeed covered at the time you incurred
or will incur a claim, and to ensure that your employer has
submitted the appropriate hours to the Plan on your behalf,
you will need to contact the Plan Administrator. Individual
Member records are not available on this web site. The Health & Welfare
Plan Booklet describes how you qualify and maintain
coverage. (Please refer to Part I of the
Health & Welfare
Plan Booklet.)
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What if I become unemployed?
The Plan includes a provision of six months of self-payment for a
Member who was covered under the Local 97 Ironworkers Health & Welfare Plan.
Please refer to Part I of the
Health & Welfare
Plan Booklet.
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When does my coverage end?
Coverage is always provided on a whole-month basis only and will be terminated when:
- Your Hour Bank falls below 110 hours and you fail to make a payment by the date
specified on the self-payment notice (Members ONLY) to bring your Hour Bank up to the
required hours; or,
- You have already make 6 consecutive self-payments to the Fund.
The Health & Welfare Plan Booklet describes extended coverage on termination and the
Self-Pay Plan. Individual Member records are not available on this web site.
To check your individual coverage, you will need to contact the Plan
Administrator.
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Who is eligible as a dependent?
Dependents eligible for benefits are:
The Spouse
of an Insured Person, and unmarried dependent children to age
21, unless the dependent child is attending a recognized school,
college or university on a full-time basis, in which case the
maximum age will be 25. A child is not a dependent if he/she is
eligible for or entitled to benefits under this
Plan as a Member.
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What is my Vision Care benefit?
The maximum amount payable during any period of 24 consecutive months shall be
90% of the actual expense incurred or $300.00 whichever is the lesser for an
eligible adult. A maximum amount of $200.00 payable during any period of 12 months
for an eligible dependent to age 19.
Please refer to the Vision Care section, under Part IX of the
Health & Welfare Plan Booklet.
Please be sure to read the entire section, including the Exclusions that are
listed.
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When did I last get glasses - am I eligible for another pair?
Individual Member records are not available on this web site. Please contact the
Plan Administrator.
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What is co-ordination of benefits?
If a Member or any eligible Dependents are entitled to
receive similar benefits simultaneously under the Health Benefit Plan or any
other group insurance plan (including Provincial Plans), to prevent over
payment, benefits payable under this Plan would be co-ordinated with the other Plan.
For example: A Member’s wife is covered under her employer’s plan
with
family coverage. The Member, his spouse and their three children are all covered
under both Plans. The responsibility of the initial reimbursement is determined
as follows: Between the Member and the spouse, whoever’s birthday falls first in
the calendar year, their plan is responsible for the initial payment of benefits
for the dependent children, then, any amounts that are not paid by that Plan are
submitted to the other spouse’s plan.
Therefore, in the event that the Member’s birthday is in April and the spouse’s
birthday is in January. The spouse’s plan would be primarily responsible for her
claims and the claims of the children. Any amounts not paid by her plan can be
submitted to the Member’s Plan for reimbursement.
Please see Part I of the
Health & Welfare Plan Booklet.
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