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's 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.
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.
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, Beneficiary Designation Form, Spousal Coverage Verification Form and HIPAA Authorization Form. Under certain circumstances, a marriage license may be required.
Please note: When multiple beneficiaries are not designated as either primary or secondary, all beneficiaries listed are primary by default.
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. In addition to the Enrollment Form, you will need to submit the required documentation listed below for your children.
- Natural child(ren) of member married to other natural parent: No documents required unless natural child’s last name differs from the household last name.
- Natural child(ren) whose date of birth is prior to date of marriage: Paternity papers, birth certificate, or legal documentation showing member is natural parent of dependent.
- Natural child(ren) of member whose natural parents are divorced: Divorce decree (with judge’s signature) of member and other parent showing who has medical responsibility of child(ren).
- Natural child(ren) of whose natural parents were never married: Paternity papers, birth certificate, or legal documentation showing member is natural parent of dependent.
If your step-child is covered under the health plan of either natural parent, the Carpenters' Plan coverage of your step-child will be secondary to the natural parent's plan. If the natural parent has no other coverage, the Carpenters' Plan will be the primary payer. In the event of a natural parent's death, a copy of a certified death certificate would be required. Copy of other insurance information from one or both natural parents or a Step Child Coverage Verification Form.
To add an adopted child, you will need to submit a copy of the child’s finalized adoption papers from the courts.
If a child is dependent on you for support because of a physical or mental disability and is not capable of self-sustaining employment, they can remain covered under the Plan beyond the age of 26. Please contact the Benefit Plans Office and they will send you an Attending Physician’s Statement of Total Disability to be completed by you and your dependent’s Attending Physician. A disabled child may be covered by the Plan as long as he or she remains incapacitated and financially dependent upon you, provided you submit proof of disability and dependency when requested. This form may need to be updated periodically upon request from the Plan.
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 Program Verification Form needs to be completed and returned to our office as soon as possible to ensure continued coverage.
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 the member's death certificate in order for the beneficiary to obtain the member’s life insurance benefit*. The certified death certificate is also 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. You should contact the Carpenters’ Pension Office to find out if they need any additional information. Please note: When multiple beneficiaries are not designated as either primary or secondary, all beneficiaries listed are considered primary by default.
The Benefit Plans Office requires a certified copy of the spouse's death certificate in order for the beneficiary to obtain the spouse’s life insurance benefit*. 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. Please complete a new Beneficiary Designation Form and HIPAA Authorization Form for yourself. Also, please contact the Carpenters’ Pension Office to find out if they need any 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. Please complete a new Beneficiary Designation Form and HIPAA Authorization Form.
*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?
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.