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.

 

What do I do if my employer does not remit my fringes?

 

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.

 

What do I do when I get divorced?

 

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.

 

When does coverage stop for my dependent children?

 

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

 

What is COBRA?

 

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. 

 

What is Coordination of Benefits?

 

Coordination of Benefits or COB coordinates benefits with other health benefits you may have such as coverage through your spouses employer.

 

What are the Health Care Benefits?

 

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).

 

What Vision Benefits are available?

 

The Plan will pay $225 towards the exam, lenses and frames every 12 months.

 

What Dental Benefits are available?

 

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.

 

How frequently are dental cleanings covered?

 

Dental cleanings or Prophylaxis are covered once every six (6) months.