1. What requires pre-certification?
2. How do I add a dependent?
3. Does the Fund cover dependents in college?
4. Are educational services covered?
5. Does the Fund cover HPP vaccine?
6. How do I Find an in-network medical provider?
7. What are my loss of time benefits?
8. Is marriage counseling covered?
9. Are orthotics covered?
10. Who are my dental benefits through?
11. Does the Plan have a Routine Preventive Care Benefit?
12. Are smoking cessation medications covered by the fund?
13. Who are my Vision benefits through?

1. What requires pre-certification?

1. All inpatient hospital admission

2. All surgeries

3. Dialysis Treatments

 4. Durable Medical Equipment

5. Endoscopy procedures

6. Enternal Feeding Equipment & Supplies

7. Epidural Spinal Injections

8. Growth Hormone Treatment

9. Home Health Care

10. Hospice Care

11. Infusion Therapy

12. Intravenous (IV) Antibiotics

13. Outpatient Chemotherapy

14. Outpatient Radiation Therapy

15. Occupational Therapy

16. Positron Emission Tomography (PET) Scan

17. Pregnancy certification when determined

18. Physical Therapy

19. Single-Photon Emission Computerized Tomography (SPECT) Scan

20. Skilled Nursing Visits

21. Sleep Studies

22. Speech Therapy

23. Synagis Injections

24. Temporomandibular Joint Disorder (TMJ) Treatment

25. Varicose Vein Procedures

26. Vision Therapy

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2. How do I add a dependent?

Contact the Fund office for a new Registration Card to be completed and to find out what additional information is required; Marriage certificate, Birth certificate etc.

3. Does the Fund cover dependents in college?

Dependent children are covered through age of 19 or up to age 24, if a full time student.

4. Are educational services covered?

Effective 08/01/09 charges for services rendered in connection with education and training for managing diabetes will be covered under the medical benefit up to $200 per person per lifetime. The medical deductible and copayments will apply. Other educational / training services are not covered under the guidelines of the Plan.

5. Does the Fund cover the HPP Vaccine?

HPP vaccine is covered for eligible dependents through age 26.

6. How do I find an in-network medical provider?

You can do one of the following:

• Contact Anthem Provider Access 800-810-2583

• Go to www.anthem.com or www.bcbs.com

• Contact the Fund office for assistance. 800-962-3158.

7. What are my Loss of Time Benefits?

A description of the loss of time benefits are as follows: *If you have a job-related injury or sickness, benefits begin on the eighth day of disability. Occupational $54.00 weekly benefit * If the injury or sickness is not related to work, benefits begin on the first day of disability due to an injury or on the eighth day of disability due to a sickness. Non-Occupational $228.00 weekly benefit Benefits are paid every two weeks for a maximum of 13 weeks. FICA (Medicare and Social Security) only, withheld. W-2 will be issued at the end of the year. Please be advised you must be unable to work to apply for the loss of time benefit. If the medical doctor is unable to give a date of return to work then he/she will need to advise your next appointment date. Failure to provide complete information could delay your Loss of Time benefit. Contact the Fund office for an application to be completed by you and your physician. The expected recovery time will initially be determined in accordance with the then current standard set by the Work Loss Data Institute.  An extension will be allowed upon validation of Medical Necessity. In no circumstances will the Benefit be paid for more than the maximum 13 weeks.                     

8. Is marriage counseling covered?

No, the Fund does not cover marriage counseling; however benefits may be available through your EAP or MAP.

9. Are Orthotics covered?

Effective December 1, 2005, the Fund will cover expenses incurred for orthopedic shoes, orthotics, or other supportive devices for the feet, if such expenses are Medically Necessary expenses incurred for diabetic shoes and toe-fillers needed as a result of diabetes. Coverage is limited to one of the following per Participant or Dependent per Plan Year: (1) No more than one pair of custom-molded shoes (including inserts provided with the shoes) and two additional pairs of inserts; or (2) No more than one pair of depth shoes and three pairs of inserts (not including the non-customized removable inserts provided with such shoes). All other orthotics are not covered under the guidelines of the Plan.

10. Who are my Dental benefits through?

Delta Dental – Group # 5617-0001 – Customer Service: 800-524-0149

www.deltadental.com (website)

11. Does the Plan have a routine Preventive Care Benefit?

Effective December 1, 2007 the Routine Preventative Care Benefits are:

 • Routine Physical Exam – o Age 2 and over: Maximum 1 visit per Plan Year at 100% up to $300. balance under Major Medical. (one additional routine GYN visit will be allowed, subject to the same $300 maximum).

• Routine Cervical Cancer Screening (Pap Smear Test) – o 1 per Plan Year covered at 100% performed by your primary care physician or GYN, otherwise, under Major Medical.

• Routine PSA Test (Prostate Caner Screening) – o  1 per Plan year covered at 100% under Major Medical.

• Mammogram (Breast Cancer Screening) – o Age 40-49: 1 every 2 plan years at 100% o Age 50 and over: 1 per Plan Year at 100% Otherwise under Major Medical

• Colorectal Cancer Screening – o Age 50 and over: 1 sigmoidoscopy every 5 Plan Years at 100% o After 50 and over: 1 colonoscopy every 10 Plan Years at 100% Otherwise under Major Medical

• Well-Child Exam & Immunizations – o 100% from birth to age 24 months for routine well child visits and all immunizations recommended by the Center for Disease Control.

• Routine Adult and Childhood Immunizations o 100 % if recommended by the physician in conjunction with routine physical exams excluding occupation or vacation travel necessity as recommended by the Center for Disease Control, (age 2 and over).

12. Are smoking cessation medications covered by the Fund?

No, the Fund does not cover smoking cessation medications under the medical portion of the Plan or Prescription Benefits.

13. Who are my Vision benefits through?

United Healthcare Vision Customer Service: 800-638-3120 www.myuhcvision.com

1. I am out of remittance forms. How can I get a supply?
2. I have questions about the appropriate contribution rates. How can I get help?
3. I need help with jurisdictional questions, work classifications, correct wage rates or other provisions of the Collective Bargaining Agreements. Who should I contact?
4. I received a letter demanding payment of delinquent fringe benefits. Who should I contact regarding this matter?
5. I received a notice concerning unpaid Working Dues or incorrect Working Dues payments. Who should I contact?
6. I received a notice advising me of shortages or overpayments on a fringe benefit report that was submitted. Who should I contact?
7. When are remittance reports and contributions due?
8. What about late payment penalties?
9. I am a newly signatory contractor, and I have no experience in dealing with Union fringe benefits. I don’t know what to do. Can someone help me?

(*Note- The use of the term "Fund" refers to the Indiana Laborers Welfare, Pension and Training Funds.)

1. I am out of remittance forms. How can I get a supply?

You can call the Fund office and ask for the Bookkeeping section. Any staff member will take your request and see that a supply is sent to you immediately or e-mail the fund at info@indianalaborer.org.

2. I have questions about the appropriate contribution rates. How can I get help?

You can call the Fund office and ask for the Bookkeeping section. We have several staff members that will gladly answer questions and help you through the process or e-mail the fund at info@indianalaborer.org.

3. I need help with jurisdictional questions, work classifications, correct wage rates or other provisions of the Collective Bargaining Agreements. Who should I contact?

All questions about the above matters should be directed to the appropriate Local Union. The Fund office cannot provide answers concerning provisions of the Collective Bargaining Agreements.

4. I received a letter demanding payment of delinquent fringe benefits. Who should I contact regarding this matter?

You should contact the Fund and ask for the Collections Department.

5. I received a notice concerning unpaid Working Dues or incorrect Working Dues payments. Who should I contact?”

All inquiries concerning Working Dues should be directed to the Indiana Laborers District Council office at 812-235-6083.

6. I received a notice advising me of shortages or overpayments on a fringe benefit report that was submitted. Who should I contact?

You should call the Fund Bookkeeping section and you will be put in contact with the staff member that initiated the notice.

7. When are remittance reports and contributions due?

Remittance reports with payment should be received at the Fund by the 10th of the month following the month in which the hours were worked. Example: Reports and payment for August hours should be received by September 10th.

8. What about late payment penalties?

Late payment penalties are authorized by the Trust Agreements that govern the operation of the Funds. The penalty is currently calculated at 10%APR. Although payment is expected by the 10th of the month following the month in which the hours are worked, late penalties to do not begin to accrue until the 1st day of the month following the month in which payments are due. Example: Reports and payment for August hours should be paid by September 10th. If not paid by September 30th, late penalties accrue starting October 1st. The Fund also has the right to impose charges for liquidated damages over and above the 10% late penalties, and will do so when warranted.

9. I am a newly signatory contractor, and I have no experience in dealing with Union fringe benefits. I don’t know what to do. Can someone help me?

There are several different types of contracts and funds for which payments must be calculated and reports prepared. For a new contractor this can naturally be confusing. The Fund Bookkeeping staff is very knowledgeable in this area, and will be happy to help. You can call the Fund Bookkeeping section and one of the staff members will gladly take all the time needed to work with you to get you started or contact the nearest local.

1. How do I become a participant for healthcare benefits?
2. Will my dependents also receive coverage?
3. How do I register?
4. When does initial coverage begin?
5. What are “qualification periods” and “coverage periods?
6. I do not have enough worked hours during the most recent qualification period. Can I still qualify for coverage based on previously worked hours?
7. I do not have enough banked hours to qualify. May I pay the difference?
8. When are my self payments due?
9. When will I receive my member card for healthcare benefits?
10. I lost my member healthcare benefits card. How do I get a replacement?
11. If I work in a state other than Indiana, will I receive credit for these hours?
12. What is needed to add my spouse and dependents to my coverage?
13. What is needed to keep my dependent eligible after they turn 19 years of age?
14. Can I terminate my dependents coverage before they turn age 19?
15. What is required to remove my ex-spouse from coverage?
16. If I lose healthcare coverage am I entitled to COBRA benefits?
17. Can I continue my welfare benefits after I retire?
18. Can I have the payments for my welfare benefits deducted from my pension check?
19. Can my spouse continue coverage after I am deceased?

1. How do I become a participant for healthcare benefits?

You may become a participant if you work for a contributing employer under a collective bargaining agreement negotiated by the Laborers International Union of North America, State of Indiana District Council.

2. Will my dependents also receive coverage?

Yes, your qualified dependents may also receive coverage. A qualified dependent could be a spouse to whom you are legally married, unmarried dependent children under age 19 (up to 24 years if they are full-time students in an accredited high school, trade school, college or university.) Various documents are required as proof of dependent status. Please call the Fund Office for these requirements.

3. How do I register?

You must register before any benefits can be paid. Registration cards are available from the Welfare Fund Office or your Local Union Office.

4. When does initial coverage begin?

You are eligible for participation after working 600 hours during your first six months of employment. If you have not worked 600 hours, you may still participate after the six month period if you have worked 260 hours during a qualification period.

5. What are “qualification periods” and “coverage periods?”

The plan is operated on “qualification periods” and “coverage periods”. If you work the required number of hours (260 hours) during a qualification period, you can participate during the next coverage period. There are three qualification periods and three coverage periods, all of which are four months in length.

6. I do not have enough worked hours during the most recent qualification period. Can I still qualify for coverage based on previously worked hours ?

Yes, you may still qualify for participation if you have sufficient “banked hours” from previous qualification periods. You must have worked either 260 hours during the most recent qualification period, 520 hours during the two most recent qualification periods, or 780 hours during the three most recent qualification periods.

7. I do not have enough banked hours to qualify. May I pay the difference?

Yes, if you are short the required hours during the most recent qualification period, you may call the Fund Office for a computation of the amount you can “self-pay” to meet the requirement for participation. (You must call the fund office for this amount because self- payments are based on work hours as they are reported to the Fund Office and because rates may vary between bargaining agreements.)

8. When are my self payments due?

Self payments must be submitted no later than the last day of the last month of the current coverage period. (Due dates: March 31st, July 31st, November 30th).

Senior Member self payments are due by the 10th day of the last month of the current coverage period. (March 10th, July 10th, November 10th).

9. When will I receive my member card for healthcare benefits?

New cards are processed twice a month (1st & 15th) and will be mailed from the Fund Office. If you are newly qualified, but have not yet received your card, you may call the Fund Office for assistance.

10. I lost my member healthcare benefits card. How do I get a replacement?

Please call the Fund Office and request a replacement card. Replacement cards are mailed twice a month (1st & 15th). In the meantime, If you need assistance with a healthcare provider or claim, you may call the Fund Office for assistance.

11. If I work in a state other than Indiana, will I receive credit for these hours?

Generally hours are reported to the Fund in the local area where the work is performed, without regard to which local the member belongs. However, many states have signed reciprocal agreements which allow hours to be transferred back to the member’s home fund. If a reciprocal agreement between the funds is in place, the member may choose to transfer his hours to his home fund by completing an Authorization for Contribution Transfer form. The member should contact the bookkeeping department to verify that the area in which they are working is covered by a signed reciprocal agreement.

12. What is needed to add my spouse and dependents to my coverage?

A new registration card. You may obtain a registration card either from your local union office or from the Welfare Fund office. Copies of marriage certificates and birth certificates are also required.

13. What is needed to keep my dependent eligible after they turn 19 years of age?

A letter of student status from the schools registrar’s office stating the dependent is a full- time student. These are due for Spring semester in January and for Fall semester in September.

14. Can I terminate my dependent's coverage before they turn age 19?

Active member’s dependents can only be terminated if they have been legally emancipated or married.

15. What is required to remove my ex-spouse from coverage?

A copy of the divorce decree and a new registration card. In order for COBRA to be offered the fund must be notified within 60 days of the divorce becoming final.

16. If I lose healthcare coverage am I entitled to COBRA benefits?

COBRA (Consolidated Omnibus Reconciliation Act) requires that group health plans offer certain individuals, who would otherwise lose coverage as a result of certain events, the opportunity to elect and pay for continued group health coverage for a specified period of time. If you lose coverage due to a qualifying event, you may be entitled to continued coverage through Cobra. Qualifying events include: Employee’s death, Employee’s divorce or court-ordered legal separation, Employee’s entitlement to Medicare, Loss of child dependency status, Chapter 11 bankruptcy of the employer. For more specific information about COBRA, please contact the Fund office.

17. Can I continue my welfare benefits after I retire?

Yes, a Senior Member Program for retirees is available through the Indiana Laborers Welfare Fund to continue coverage for the member and their dependents.

18. Can I have the payments for my welfare benefits deducted from my pension check?

Yes, monthly deductions can be taken from your Pension check to cover the cost of the Senior Member Program.

19. Can my spouse continue coverage after I am deceased?

Yes, a covered Spouse can continue coverage as the survivor.