Health and Welfare Plan / FAQs
How do I find an In-Network doctor or dentist?
While on the Benefits home page of the website www.carpdc.org/BenefitServices, our Network Partners' logos are located at bottom of the page. Each logo on this page links you to that particular provider’s website. Each site has links to find doctors/dentists/specialists in our network, when applicable. To find an In-Network provider with one of our partners, links have been included here to assist you.
How do I add my spouse to my health insurance coverage?
Your “spouse” is your legal partner in marriage by a civil or religious ceremony performed in accordance with the laws of the state in which you reside. For the purposes of the Plan, “spouse” includes a common law spouse only in the State of Kansas with administrative review and approval.
To add a spouse to your Health and Welfare coverage, you are required to complete an enrollment form with it's required documentation as outlined on page 2 of the enrollment form, beneficiary designation form, spousal verification form and HIPAA authorization. You may find all of these forms here.
How do I add my children to my health insurance coverage?
To add any child up to age 26, you need to complete an enrollment form, which you can find on on our website here, as well as provide the necessary documents as outlined on the second page of the enrollment form.
My spouse has changed employment. Do I need to let you know?
If your spouse’s employment status changes (affecting group health coverage), a spousal coverage verification form needs to be completed and returned to our office as soon as possible to ensure continued coverage. You may find this form on our website here.
What are my preventive care benefits?
Your preventive care benefits, which are included in your Carpenters' Plan coverage at no cost to you, the member, are best detailed on government's health care website. Click here for a detail of these benefits.
I want to save money and order my prescriptions through Express Scripts Home Delivery. How do I do this?
There are two (2) ways to manage your medications easily with Express Scripts Home Delivery.
- Visit Express Scripts website to create a personal account if you do not already have one.
Click here for step-by-step instructions for setting up your personal Express Scripts account. All dependents 18 and over will need to complete separate registration.
After you have set up your account and logged in, the Home screen should include all of your active prescriptions, both at retail and Home Delivery. If you wish to view and fill prescriptions for your spouse and/or dependents, select household view while setting up your account (refer to the step-by-step instructions linked above for detail). If you have already set up your account, you may choose household view by updating your Express Scripts online profile. If you have dependents under the age of 18 on your account who are covered under your insurance plan, they should already be connected with your account. If they are not, please contact Express Scripts by phone at 800.939.2134.
- Call Express Scripts by phone Toll-Free: 800.939.2134. An Express Scripts representative will help you with all of your prescription drug orders.
What do I need to do if I become legally separated or divorced?
Upon legal separation or divorce, the Plan must be notified to remove a spouse from coverage. A copy of the legal separation court document or divorce papers is required. Your spouse (and any step-children) will be removed from coverage on the last day of the month in which your divorce or legal separation is finalized. In order for your ex-spouse (and any step-children) to be eligible for COBRA continuation coverage, notification to the Plan must be done within 60 days of the date of divorce or legal separation.
What do I need to do in the event of the death of a covered family member?
The Benefit Plans Office requires a certified copy of a death certificate in order to process the life insurance benefits.* Refer to the information below for death benefits related to each covered family member.
The certified death certificate is required for self-pay refunds (if applicable), possible vacation benefits, surviving dependent’s benefits, and for the Pension Department to process any benefits due under the Pension Plan. Contact Carpenters’ Retirement Services to find out if their office requires additional information. Please note: When multiple beneficiaries are not designated as either primary or secondary, all beneficiaries listed are considered primary by default.
The certified death certificate is also used by the Pension Department to process Pension information. If your deceased spouse was the beneficiary of your life insurance benefit, you will need to appoint a new beneficiary. You may do so by completing a new beneficiary designation form and HIPAA authorization form which may be found here. Also, please contact Carpenters’ Retirement Services to find out if their office requires additional information.
The Benefit Plans Office requires a certified copy of the dependent child's death certificate in order for the beneficiary to obtain the dependent’s life insurance benefit.* If your deceased child was the beneficiary of your life insurance benefit, you will need to appoint a new beneficiary.You may do so by completing a new beneficiary designation form and HIPAA authorization form which may be found here.
*For Life Insurance Benefits, refer to the current Health & Welfare Summary Plan Description.
How much life insurance do I have if I'm covered under the health plan?
Life insurance on the life of a member is $8,000.
When will I become covered under the health plan? How will I know if I've earned coverage?
Outside Eligibility: An employee initially becomes eligible for benefits on the first day of the month following the employee’s completion of at least 500 credit hours during the preceding six consecutive months.
Inside Eligibility: An employee initially becomes eligible for benefits in the Inside Eligibility class on the first day of the month following the employee’s completion of at least 250 credit hours during the preceding six consecutive months.
Special Participation Eligibility: An employee initially becomes eligible for benefits in the Special Participation Eligibility class on the first day of the month following the month in which the employer first makes a timely contribution on the employee’s behalf.
Outside Eligibility: Members employed in work covered by a collective bargaining agreement or participation agreement requiring contributions to this Plan for hours (not limited to 133 hours per month)
Inside Eligibility: Members employed in work covered by a collective bargaining agreement requiring contributions to this Plan for all hours of work up to a maximum of 133 hours per month
Special Participation Eligibility: Members of a special participation group
What do I do if I run out of health coverage?
You have two options under the Plan if your coverage is terminating due to low or no hours worked.
- Minimum and Difference Payments
If you have not earned enough credit hours in a contribution quarter to maintain active eligibility, you may elect to maintain continuous active eligibility by making self-payments directly to the Fund. These are referred to as “minimum/difference payments.” If you make timely payments for a particular benefit quarter, in the required amount, your eligibility will be extended through that benefit quarter.
More information on Minimum Difference Payments can be found here.
Under COBRA, you and your covered dependents have the right to elect to continue your coverage under the Plan in lieu of minimum/difference payments if you (or your covered dependents) would otherwise lose coverage because of a qualifying event (refer to the chart below). Each qualified beneficiary has the independent right to elect COBRA coverage. A qualified beneficiary means each person (you, your spouse and your dependents) covered by the Plan on the day before a qualifying event, and any child born to you or placed for adoption with you while you are covered by COBRA. You may elect (but you may not waive) COBRA continuation on behalf of your spouse, as long as your spouse is a qualified beneficiary. Parents may elect COBRA continuation coverage on behalf of their dependent children, as long as the dependent children are qualified beneficiaries.
Continuation coverage under COBRA includes medical, prescription drug, dental and vision coverage that the qualified beneficiary would have been entitled to if the qualifying event had not occurred. It does not include weekly accident and sickness benefits, life insurance, or AD&D.
More information on COBRA can be found here.
Am I responsible for pre-certifying any surgeries or medical services?
If you see an In-Network provider for your care, your network provider will handle any pre-certification required by the Plan. If you see an Out-of-Network provider for your care, you must ensure that the pre-certification has been obtained as required by the Plan by contacting Cigna at 800.244.6224 or www.CIGNA.com.
Why do I have to have an X-ray before I can have the CAT scan my doctor ordered?
CAT scan expose you to more radiation. X-Rays use less radiation and can often tell the doctor what he/she needs to know. In addition, overall cost to the member (coinsurance) and the Plan for X-ray services are less expensive than the cost for a CAT scan. If a member meets medical necessary for a CAT scan, the doctor can provide additional information to Coventry to explain why a CAT scan is needed instead of an X-ray.