LABORERS’ METROPOLITAN
DETROIT HEALTH CARE FUND
COMMON QUESTIONS ASKED
How are my benefits Funded?
The primary source of
financing for the benefits provided under the Health Care Fund and for the
expenses of Fund operations is employer contributions.
What are the Fund’s
eligibility requirements?
Initial eligibility requires
700 hours of contributions within six (6) months or less.
Continuing eligibility
requires 300 hours of employer contributions within three (3) months or
less. The participant is then eligible
for the next two (2) months.
First call your
employer. There may be a very good
reason that the fringes have not been remitted.
If your employer cannot explain the reason to your satisfaction, you
should contact the Local Union.
How can I add my
dependents to the Plan?
Complete a “Yearly
Coordination of Benefits and Dependent Status Statement Form” and submit copies
of marriage or birth certificates.
You must send a copy of your
complete divorce decree otherwise coverage will be maintained for your
ex-spouse. If the Fund pays for benefits
that should not be paid because your spouse no longer meet
the definition of a dependent, you will be held responsible.
Dependent children are
covered through the end of the year in which they turn 19 unless they meet the
requirements for maintaining coverage.
The Plan requires that the dependent be a full time student with at
least 12 credit hours per semester
Can I continue coverage
when I retire?
Yes provided you meet the
retiree requirements for maintaining coverage.
What do I do if I am
injured and cannot work?
The Fund provides disability
credit which may continue your coverage for health care benefits. You should complete a disability form.
What are the self-payment
rates?
Active participant and family --------------------------------- $328.60 per month
COBRA is the Consolidate Omnibus
Budget Reconciliation Act of 1986. COBRA
requires that the Fund provide coverage for participants and their dependents
that may not otherwise be offered. COBRA
is available for dependents who no longer meet the definition of a dependent as
defined by the Plan. The rates are 102%
of the actual cost of providing benefits.
Coordination of Benefits or
COB coordinates benefits with other health benefits you may have such as
coverage through your spouses employer.
The Fund has contracted with
PPOM to provide participants and the Fund with discounts on medical
services. If a PPOM participating
provider is utilized the participant has no out of
pocket expenses for hospitalization and only a $5.00 co-payment for office
calls. For further details regarding the
medical benefits available, please refer to the Summary Plan Description (SPD).
The Plan will pay $225
towards the exam, lenses and frames every 12 months.
The Dental Benefits are based
up a fee schedule. The fee schedule
provides for approximately 75% reimbursement of preventive services and 50%
reimbursement of restorative services.
Dental cleanings or
Prophylaxis are covered once every six (6) months.