Health Benefit FAQs
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. Much of the information asked commonly by Members is now available from the NEW D.A. Townley My Claims portal and mobile app. If you still have questions after reading this information, please contact the Plan Administrator.
How can I sign up for the NEW D.A. TownleyMy Claims portal and mobile app?
Go to: www.datownley.com/myclaims/ and look for Online Registration in the resources section on the right side of the page. Click on the link. Complete all the required fields and acknowledge that you have read the terms and conditions. Click on the Submit button and it will automatically direct you to the My Claims portal. Set up your account on the My Claims portal by clicking on Register Account. Enter your group number (70682) and your Client ID number from your pay-direct card, along with your postal code and date of birth. Then click Next. Set up your username and password. Please note: you can only create one username and password for the same coverage. Then click Sign Up and accept the terms and conditions. Now you can download the free D.A. Townley My Claims app by visiting the App Store for IOS devices or Google Play for Android devices. Once downloaded, sign in using your username and password you assigned previously.
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 this section of the Health & Welfare Plan Booklet.)
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 this section of the Health & Welfare Plan Booklet.
When does my coverage end?
a) Coverage will terminate when there are insufficient hours in the Member’s Hour Bank to allow for a deduction of 110* hours. Coverage for a Non-Member will terminate when there are insufficient hours in the Hour Bank to allow for a deduction of 130* hours.
*effective September 2020 hours/November 2020 coverage
b) Coverage for Members will be terminated immediately and the Hour Bank will be forfeited for any Member who is found to be working for a non-signatory Ironworker Contractor.
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.
Who is eligible as a dependent?
|A dependent for this Plan is defined as:
a) The spouse of a covered Member;
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.
To find out more about Coordination of Benefits please refer to this section of the Health & Welfare Plan Booklet.