Frequently Asked Questions
What should I do if someone in my family has other group insurance?
I received a drug card for Envision/RX Options. How does that work?
| Q. When am I eligible for insurance? |
| A. The 1st day of the month following 500 hours of employers
contributions.
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| Q. I understand that my coverage is through the Local 265 Welfare Fund. Why do we have a Blue Cross Blue Shield ID card? |
| A.
You are right, the Local 265 Welfare Fund does provide the benefits for all participants.
We use the Blue Cross Blue Shield PPO Network to obtain discounts from participating
hospitals and doctors. You should use a PPO hospital or doctor whenever possible. This
will save money for the Fund and you will have to pay less out of pocket expense.
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| Q. What coverage do we have under the Plan? |
| A.
To find out your coverage you can 1) review your Summary Plan Description booklet, 2)
check out the benefits portion of the website, 3) send us a specific question by letter or
email regarding any benefit or 4) give us a call at 630 668-7260.
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| Q. What is pre-certification and who is Med-Care Management? |
| A.
Pre-certification means that any hospital confinement or surgery should be reviewed, so
that you and the Fund are sure that you are receiving the most appropriate treatment. When
you pre-certify a hospital stay or surgery, the Fund waives the $100 basic deductible.
Med-Care Management is the provider that the Fund uses for pre-certification. You, your
doctor or the hospital may contact Med-Care Management for pre-certification. Their number
is 1-800-375-9173. Med-Care Management will also assist you when you need special services
such as nursing care or the rental or purchase of durable equipment.
Med-Care also provides pre-certification for Mental Health and Alcohol or
Substance Abuse treatment.
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| Q. Do I need a claim form? |
| A. When you use a Blue Cross Blue Shield provider, the doctor will send
their bill directly to BCBS who will electronically submit the billing to the Fund Office.
If your claim is the result of an injury, you should contact the Fund Office for a
participant’s claim form so that the form is on hand when your bill(s) arrive. If
additional information is needed, you will be contacted. If
you do not use a PPO doctor, a claim form will be needed from you and the
doctor. If you are filing for disability benefits, we will need a claim form from
you and your doctor, even if the doctor is a PPO provider. |
| Q. What should I do if some in my family has other group insurance? |
| A.
They should follow all the procedures of their insurance plan and upon payment of the
claim, copies of the Explanation of Benefits forms should be sent to the Local 265 Welfare
Fund for consideration of outstanding balances.
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| Q. I received a drug card for Envision/RX Options. How does that work? |
| A.
The Fund uses Envision/RX Options for pharmacy discounts. You show your
card at the pharmacy and pay only your share of the drug expense. Normally, your share for
brand drugs will be $15 or 20% whichever is less. For generic drugs, you will pay $4. You
will save even more by using mail order. A 90-day supply would be $12 for brand or $4 for
generic.
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| Q. Do I show my Blue Cross Blue Shield Card at the dentist? |
| A.
Yes, all dental claims come directly to the Fund Office. Please contact the Fund Office for
a claim form or request a form online on the website.
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| Q. Do I show my Blue Cross Blue Shield Card for vision care? |
| A.
Vision claims can be through the Fund Office or through the Eye Med Managed
Care network. The Plan pays expenses of up to a total of $200 each year for any
combination of an exam, frames, lenses or contacts. A claim form and itemized bills need
to be submitted for payment. Or you may use an Eye Med Managed Care provider and
receive an exam, and glasses or contacts at no cost to you. No claim form is needed if you
use an Eye Med Managed Vision Care provider.
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| Q. What should I do if I lose any of my ID cards? |
| A.
Contact the Fund Office online or by phone to
report the loss. New cards will be sent out within a few days.
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| Q. What happens if there is a change in my family status? |
| A. Contact the Fund Office and they will advise you of what is needed to make a change. |