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Active Members

Health

How do I determine my eligibility?

Your eligibility is determined based on whether you pass any one of three tests with respect to the hours paid on your behalf: a 200/hour/3 month test, a 400 hour/6 month test and an 800 hour/12 month test. For more information on eligibility, or to keep track of your individual hours and eligibility, visit the Member's Only section of our Web site. If you have any questions regarding the commencement of your eligibility, call the Fund Office.

How do I add my spouse to the Health Plan?

Call the Health Fund Office to request the paperwork you must fill out to add your spouse to the Plan. Retirees, on retiree copay, have 60 days to notify the Fund Office of the marriage. You will be required to submit a copy of your marriage certificate and your spouse's Social Security number. We handle all participant information, including Social Security identification numbers, within strict guidelines with respect to privacy and security. 

Which insurance is primary when my spouse has insurance too?

The Fund would be the primary payer for you and the secondary payer for your spouse. If you have children, we follow the birthday rule to determine coordination of benefits between our Fund and the other carrier. The spouse whose birthday falls first within the year holds the primary insurance for the children. (If a Local 478 Member's birthday is February 15, and his spouse's birthday is August 15, the Member would hold the primary insurance for the children.) The year of birth is not considered. 

How do I add my newborn child?

Call the Local 478 Fund Office as soon as the child is born. You'll need to provide the baby's name and date of birth, and a copy of the long-form birth certificate. This should be done as soon as possible to avoid any delay in processing the newborn's claims. We will need the baby's Social Security number as soon as it is available in order to continue processing benefit payments. 

How long do you cover dependent children?

The Fund covers eligible dependents until the age of 26.  Dependent children who are declared disabled by the Social Security Administration may be covered indefinitely. You should notify the Fund Office if your child has a disability. We need each covered dependent's Social Security number in order to process his or her claims. 

 

How do I request medical and dental cards?

Once you become eligible for Health Benefits in our system, your medical and dental cards are automatically sent to you. One set of (2) cards will be sent for the family with the Member's name and ID. If you need additional medical cards, please contact the Health Fund office, if you need Dental cards please contact Delta Dental at 1-800-452-9310. 

If I am unemployed for a long period, how will I know if my health benefits are running out?

If your eligibility terminates, possibly because of a long gap in employment, the Fund Office will notify you within approximately 7-10 days. You can view the hours paid in on your behalf and your health benefit eligibility on the Member's Only section of this Web site. 

What if I think my employer has been delinquent in submitting my hours?

If you are concerned that your employer might be delinquent, call the Health and Contributions departments of the Local 478 Fund Office. If your employer is not paying your benefit contributions, we may already be aware of the situation and taking action to collect the amounts due on your behalf. There are some rare instances where we might not know that a member is working for a particular employer. Therefore, you should notify us of any problems. Always keep copies of your pay stubs and any other documentation in case a problem comes up. 

How do I find out if my claim has been paid?

You will receive an explanation of benefits statement from the Fund Office to show that a claim has either been paid or denied. You can also check your benefits information on the I-Site portal (IUOE Local 478 Benefit Funds (issisystems.com)), or by calling the Local 478 Fund Office and asking for the claims department. Remember, the Fund is required by law to have a fully executed HIPAA designation form before we can discuss claim-related issues involving participants who are 18 or older with other individuals, including parents and spouses.

Do I need a referral from my primary care doctor for medical services?

No, this plan does not require you to obtain a referral to receive medical benefits.

Do I need a prior authorization for benefits?

The only time you need to obtain a prior authorization is before you receive in-patient hospital or Rehabilitation stays from Telligen by calling them at 1-833-374-9833. This requirement applies only to Active Members and Pre-Medicare Retiree participants. Members can contact the Health Fund Office for support or confirmation of authorization.

Can I get a second opinion on a diagnosis I am concerned about?

Yes, the Fund will cover a second opinion provided your physician submits the claim according to the Plan rules.

How do I find out if my doctor is in the Anthem Blue Cross and Blue Shield network?

Call Anthem at 1-800-810-2583, or go to their Web site at www.bcbs.com.

Am I eligible for vision benefits?

Adults are eligible for vision benefits once every two years, and children 12 and under are eligible once a year. If you are not sure when you last used your vision benefit, contact the Health Fund Office and ask for the claims department. 

What happens if I use a non-participating provider?

If you use a non-participating provider for dental, medical or vision visits, your claims will still be considered, but they will be paid at a different rate and may be subject to a deductible. For more information, contact the Fund Office.

How do I obtain prior authorization for behavioral health or substance abuse visits/hospitalization?

Contact Telligen at 1-833-374-9833.

How much is my prescription co-pay?

If you purchase your prescription at a pharmacy that participates with the OPTUMRx network, you will pay the following co-pays or the cost of the prescription: $15 for generic, $30 formulary, or $45 non-formulary for a 30-day supply. The co-pays for OPTUMRx order drugs are: $25 for generic, $55 for brand and $85 for brand (non-formulary). 

How do I obtain a formulary list?

Formulary lists are updated every three months. You can find the latest list at www.OPTUMRx.com, or by calling OPTUMRx at 855-295-9140. 

How do I submit a prescription claim for a refund?

If you purchased prescriptions on your own or have other insurance, you may submit a paper claim for a refund. You need to submit the prescription receipt with a prescription claim to OPTUMRx at the address provided on the back of the claim form. 

How do I obtain a prescription claim form?

Contact OPTUMRx at 855-295-9140 or the Local 478 Fund Office. 

What are my disability benefits?

Disability benefits are paid for time lost due to injury or illness that is not related to work. This short-term benefit is paid at $800 a week (paid bi-weekly) and has required taxes withheld for a maximum of 182 days or 26 paid weeks. However, payment is based on the Medical Disability Advisor according to the diagnosis that your doctor submits, so it may cover less than 26 weeks. 

Are my disability benefit payments taxed?

Yes. The law requires us to deduct Social Security tax and CT FMLA automatically. You may choose to have federal or state taxes taken out at the time of payment by completing and submitting the appropriate tax forms. 

How do I file for disability benefits?

You can obtain a disability claim and tax forms from the Local 478 Health Fund Office. 

How often will I receive a disability payment?

Disability benefits are paid every other week on a pay period basis ending on Saturday. 

Is my spouse eligible for disability benefits?

Disability benefits are for Active Members only.  

Who is my death benefit beneficiary?

If you are not sure who your beneficiary is, contact the Fund Office. You can change your beneficiary at any time by completing the appropriate beneficiary form. 

What is my death benefit?

For Active Members, the death benefit is $25,000. For accidental death, the benefit doubles to $50,000. If you are on our retiree plan, the death benefit is $5,000. This taxable benefit is paid to the beneficiary of your choice at the time of death and is fully taxable. 

Can I designate more than one beneficiary?

You can designate as many beneficiaries as you want. 

What if I go to work for a non-union employer doing work covered by our Collective Bargaining Agreement?

Your Health Benefits will be terminated immediately and you will not be eligible for COBRA.  You will be prohibited from taking an Annuity Distribution. If you are receiving a pension, your Pension Benefit and any Retiree Health Benefits you may be receiving will be terminated. You will be ineligible for SUB, referral by the Local, and Training classes.

What if I am called to or discharged from Active Military duty?

You must notify both the Referral Hall and Fund Office promptly regarding both. You may be eligible for special benefits through the Health, Pension, Annuity and SUB funds. 

What if I am an Active Member who is required to begin receiving Pension and Annuity benefits under the law that requires me to do so starting on the April 1 of the year following the calendar year in which I turned age 73.

Such Members are considered to be Active Members and may earn and receive Active Health benefits and SUB. Members who voluntarily retire prior to being required to begin receiving Pension and Annuity benefits may work unlimited hours upon attainment of age 73, but such individuals are not eligible for SUB. 

What happens if I incur an accidental injury, whether or not it is incurred in connection with employment?

Contact the Fund Office immediately. The Health Fund must determine whether there is another party who is responsible for paying any claims related to the injury, via a third-party lawsuit or via a worker's compensation claim . Depending on the particular circumstances, the Health Fund may pay such claims pursuant to an agreement to reimburse the Fund for any bills it paid. If you have a work-related claim or you are deemed disabled, you may also be entitled to limited Pension credits. Also, you may be able to collect SUB benefits if you have been released for light duty.

What if I am injured or ill to the extent that I cannot work for an extended period of time?

Contact the Health Fund Office immediately. You may qualify for the Health Fund's weekly disability benefit. You should be aware that Members cannot receive disability benefits and SUB at the same time as SUB requires that you are available and physically capable of accepting work in covered employment. In addition, you may be eligible for a limited amount of Pension credit. 

What if I am declared disabled by the Social Security Administration?

Contact the Health and Contributions departments of the Local 478 Fund Office immediately. You may qualify for a disability Pension and Retiree Health Benefits.

Annuity

What if I go to work for a non-union employer doing work covered by our Collective Bargaining Agreement?

Your Health Benefits will be terminated immediately and you will not be eligible for COBRA.  You will be prohibited from taking an Annuity Distribution. If you are receiving a pension, your Pension Benefit and any Retiree Health Benefits you may be receiving will be terminated. You will be ineligible for SUB, referral by the Local, and Training classes.

What if I go to work in the geographical jurisdiction of another Operating Engineers Local?

You should contact both our Referral Hall and Fund Office and those of the Local in which you intend to work to determine whether the other Local will reciprocate benefit contributions back to Local 478. Find out what forms the other Local will require. Please note that most other Locals do not have SUB, so you probably would not accrue any SUB from work performed in such instances, and some do not have an Annuity/401K Plan. Finally if you work in a jurisdiction where they utilize a stamp program, you should pay particular attention to their requirements for redeeming your stamps. 

What if I am called to or discharged from Active Military duty?

You must notify both the Referral Hall and Fund Office promptly regarding both. You may be eligible for special benefits through the Health, Pension, Annuity and SUB funds. 

What if I am an Active Member who is required to begin receiving Pension and Annuity benefits under the law that requires me to do so starting on the April 1 of the year following the calendar year in which I turned age 73.

Such Members are considered to be Active Members and may earn and receive Active Health benefits and SUB. Members who voluntarily retire prior to being required to begin receiving Pension and Annuity benefits may work unlimited hours upon attainment of age 73, but such individuals are not eligible for SUB. 

What if I think my employer has been delinquent in submitting my hours?

If you are concerned that your employer might be delinquent, call the Health and Contributions departments of the Local 478 Fund Office. If your employer is not paying your benefit contributions, we may already be aware of the situation and taking action to collect the amounts due on your behalf. There are some rare instances where we might not know that a member is working for a particular employer. Therefore, you should notify us of any problems. Always keep copies of your pay stubs and any other documentation in case a problem comes up. 

Pension

What if I go to work for a non-union employer doing work covered by our Collective Bargaining Agreement?

Your Health Benefits will be terminated immediately and you will not be eligible for COBRA.  You will be prohibited from taking an Annuity Distribution. If you are receiving a pension, your Pension Benefit and any Retiree Health Benefits you may be receiving will be terminated. You will be ineligible for SUB, referral by the Local, and Training classes.

What if I am called to or discharged from Active Military duty?

You must notify both the Referral Hall and Fund Office promptly regarding both. You may be eligible for special benefits through the Health, Pension, Annuity and SUB funds. 

What if I am an Active Member who is required to begin receiving Pension and Annuity benefits under the law that requires me to do so starting on the April 1 of the year following the calendar year in which I turned age 73.

Such Members are considered to be Active Members and may earn and receive Active Health benefits and SUB. Members who voluntarily retire prior to being required to begin receiving Pension and Annuity benefits may work unlimited hours upon attainment of age 73, but such individuals are not eligible for SUB. 

What happens if I incur an accidental injury, whether or not it is incurred in connection with employment?

Contact the Fund Office immediately. The Health Fund must determine whether there is another party who is responsible for paying any claims related to the injury, via a third-party lawsuit or via a worker's compensation claim . Depending on the particular circumstances, the Health Fund may pay such claims pursuant to an agreement to reimburse the Fund for any bills it paid. If you have a work-related claim or you are deemed disabled, you may also be entitled to limited Pension credits. Also, you may be able to collect SUB benefits if you have been released for light duty.

What if I am injured or ill to the extent that I cannot work for an extended period of time?

Contact the Health Fund Office immediately. You may qualify for the Health Fund's weekly disability benefit. You should be aware that Members cannot receive disability benefits and SUB at the same time as SUB requires that you are available and physically capable of accepting work in covered employment. In addition, you may be eligible for a limited amount of Pension credit. 

What if I am declared disabled by the Social Security Administration?

Contact the Health and Contributions departments of the Local 478 Fund Office immediately. You may qualify for a disability Pension and Retiree Health Benefits.

What if I think my employer has been delinquent in submitting my hours?

If you are concerned that your employer might be delinquent, call the Health and Contributions departments of the Local 478 Fund Office. If your employer is not paying your benefit contributions, we may already be aware of the situation and taking action to collect the amounts due on your behalf. There are some rare instances where we might not know that a member is working for a particular employer. Therefore, you should notify us of any problems. Always keep copies of your pay stubs and any other documentation in case a problem comes up. 

SUB

Am I eligible for SUB?

Your Contributing Employer(s) must have paid at least 300 hours of contributions on your behalf for work in Covered Employment in the Plan Year prior to the Plan Year in which you apply for SUB Fund benefits.  

Can I collect SUB if I worked one day in that week?

If eligible, you may collect a SUB check if you work only one day out of any given week that falls within the SUB Fund Benefit Year. In addition to being paid for one day of work, you may also receive holiday pay during that same week and still qualify for SUB. Please note that a copy of your pay stub may be required. 

As an active Retiree, may I collect SUB benefits?

No

Can I collect SUB while on a Workman's Compensation claim or called to Active Military Duty?

In order to collect SUB, you must be available for work. If you are released for light duty work and are receiving a state unemployment check, you may be eligible for benefits. An otherwise eligible participant who did not collect SUB benefits during a benefit year solely because he or she was receiving workers compensation benefits, performing military service or performing work as a temporary organizer, may carry over the SUB benefit weeks which were lost to the Benefit Year immediately following the benefit year in which the participant was on worker's compensation benefits or in the military. You should always call the SUB Fund with any carryover question. 

What if my employer is delinquent in paying contributions?

You should always submit your SUB claim, which you can obtain from the CT Unemployment website or your local unemployment office, to the SUB Fund within one month of the date on which it was issued. Once we receive your employer contributions and establish your eligibility for the claims you submit, we will reprocess those claims and pay any SUB benefits to which you are entitled. You may also submit appropriate evidence to the SUB Fund in order to establish your work record. Such evidence could include payroll checks, payroll reports, earnings reports, or similar documentation. You will be paid retroactively once the contributions are received only if your proof was submitted on a timely basis. 

Am I required to come in person again?

The Board of Trustees ruled in 2008 that you do not have to appear in person. You simply continue to complete and submit the Registration Form to the SUB Fund with or without a copy of your unemployment documentation. Please remember we cannot accept the pay stub or bank statements. We need a clear photocopy of your claim summary or an unemployment verification from The Department of Labor Web site. You may also be required to complete new tax forms. 

Can I collect SUB while out on disability?

In order to be eligible for SUB, participants must be involuntarily unemployed, available for work, and must not be receiving a medical disability or Social Security check. 

When does SUB begin & End?

The Benefit Year starts with the first full week in November that includes a Monday and ends with the last week in April that includes a Friday. 

What if I am not receiving an Unemployment check?

Typically, a person who is not collecting an unemployment check cannot collect SUB. There are a few exceptions to this rule, including: exhausted benefits with Unemployment, waiting weeks on opening new claims, and coverage while undergoing a wage investigation. For more information, contact the SUB Fund. 

Do I need to submit state documentation weekly?

For your convenience, State Unemployment benefit claim summaries and/or unemployment verification supporting a participant's claim must be received by the SUB Fund within one month of their issue date. 

What if I go to work for a non-union employer doing work covered by our Collective Bargaining Agreement?

Your Health Benefits will be terminated immediately and you will not be eligible for COBRA.  You will be prohibited from taking an Annuity Distribution. If you are receiving a pension, your Pension Benefit and any Retiree Health Benefits you may be receiving will be terminated. You will be ineligible for SUB, referral by the Local, and Training classes.

What if I go to work in the geographical jurisdiction of another Operating Engineers Local?

You should contact both our Referral Hall and Fund Office and those of the Local in which you intend to work to determine whether the other Local will reciprocate benefit contributions back to Local 478. Find out what forms the other Local will require. Please note that most other Locals do not have SUB, so you probably would not accrue any SUB from work performed in such instances, and some do not have an Annuity/401K Plan. Finally if you work in a jurisdiction where they utilize a stamp program, you should pay particular attention to their requirements for redeeming your stamps. 

What if I am called to or discharged from Active Military duty?

You must notify both the Referral Hall and Fund Office promptly regarding both. You may be eligible for special benefits through the Health, Pension, Annuity and SUB funds. 

What if I am an Active Member who is required to begin receiving Pension and Annuity benefits under the law that requires me to do so starting on the April 1 of the year following the calendar year in which I turned age 73.

Such Members are considered to be Active Members and may earn and receive Active Health benefits and SUB. Members who voluntarily retire prior to being required to begin receiving Pension and Annuity benefits may work unlimited hours upon attainment of age 73, but such individuals are not eligible for SUB. 

What happens if I incur an accidental injury, whether or not it is incurred in connection with employment?

Contact the Fund Office immediately. The Health Fund must determine whether there is another party who is responsible for paying any claims related to the injury, via a third-party lawsuit or via a worker's compensation claim . Depending on the particular circumstances, the Health Fund may pay such claims pursuant to an agreement to reimburse the Fund for any bills it paid. If you have a work-related claim or you are deemed disabled, you may also be entitled to limited Pension credits. Also, you may be able to collect SUB benefits if you have been released for light duty.

What if I am injured or ill to the extent that I cannot work for an extended period of time?

Contact the Health Fund Office immediately. You may qualify for the Health Fund's weekly disability benefit. You should be aware that Members cannot receive disability benefits and SUB at the same time as SUB requires that you are available and physically capable of accepting work in covered employment. In addition, you may be eligible for a limited amount of Pension credit. 

What if I think my employer has been delinquent in submitting my hours?

If you are concerned that your employer might be delinquent, call the Health and Contributions departments of the Local 478 Fund Office. If your employer is not paying your benefit contributions, we may already be aware of the situation and taking action to collect the amounts due on your behalf. There are some rare instances where we might not know that a member is working for a particular employer. Therefore, you should notify us of any problems. Always keep copies of your pay stubs and any other documentation in case a problem comes up. 

Local 478

What is a union?


A union is a group of employees who join together within a company to bargain collectively for better wages, stronger benefits and safer working conditions. 

What do unions do?

A union’s primary objective is to secure good contracts for its members and to enforce the provisions of that contract. The union also administers some of the contract's important benefits directly. Often these include health plans, pensions and labor/management partnerships and trusts. 

How do you organize with the Operating Engineers?

Employees who want to join the Operating Engineers sign a “union authorization card”. When a majority of employees sign cards, they are forwarded, in most cases, to the National Labor Relations Board (NLRB). The NLRB then schedules and conducts a secret ballot election. In some cases, when a majority of workers sign cards the company will recognize the union. When the union is certified, the company is required by law to bargain over wages, benefits and working conditions. 

If I sign an authorization card do I have to vote yes in the election? What if I change my mind?

The Operating Engineers are committed to organizing workers that want our representation. Organizing is not about holding a vote; it is about gaining a voice in the workplace. When the NLRB conducts a union election it's a secret ballot. No one has any right to know how you voted. 

How does the union work out problems with management?

Through the grievance procedure. The contract spells out what the grievance procedures are and explains how conflicts are to be resolved. When management engages in unfair conduct or violates a provision of the contract there are steps spelled out in the contract to resolve the problem. First, talk with your supervisor. When they refuse to do anything about it, go to your shop steward to get help. The steward sits down with you and management and tries to talk about the issue. If it can't be resolved at this meeting, a business agent from the union approaches the company to talk the issue over. If the problem still cannot be resolved to everyone's satisfaction, the business agent appeals to upper management. If this step fails, both parties bring in a neutral arbitrator to hear evidence and order a final resolution of the problem. 

What if I go to work for a non-union employer doing work covered by our Collective Bargaining Agreement?

Your Health Benefits will be terminated immediately and you will not be eligible for COBRA.  You will be prohibited from taking an Annuity Distribution. If you are receiving a pension, your Pension Benefit and any Retiree Health Benefits you may be receiving will be terminated. You will be ineligible for SUB, referral by the Local, and Training classes.

What if I go to work in the geographical jurisdiction of another Operating Engineers Local?

You should contact both our Referral Hall and Fund Office and those of the Local in which you intend to work to determine whether the other Local will reciprocate benefit contributions back to Local 478. Find out what forms the other Local will require. Please note that most other Locals do not have SUB, so you probably would not accrue any SUB from work performed in such instances, and some do not have an Annuity/401K Plan. Finally if you work in a jurisdiction where they utilize a stamp program, you should pay particular attention to their requirements for redeeming your stamps. 

What if I am called to or discharged from Active Military duty?

You must notify both the Referral Hall and Fund Office promptly regarding both. You may be eligible for special benefits through the Health, Pension, Annuity and SUB funds. 

What if I think my employer has been delinquent in submitting my hours?

If you are concerned that your employer might be delinquent, call the Health and Contributions departments of the Local 478 Fund Office. If your employer is not paying your benefit contributions, we may already be aware of the situation and taking action to collect the amounts due on your behalf. There are some rare instances where we might not know that a member is working for a particular employer. Therefore, you should notify us of any problems. Always keep copies of your pay stubs and any other documentation in case a problem comes up. 

Training / Apprenticeship

What is an Operating Engineer?

Operating Engineers work on construction projects. We do roadwork, build bridges and buildings, do land clearing, install natural gas pipelines, work in quarries and more.
We represent the OPERATORS who run the equipment used in construction such as bulldozers, backhoes, forklifts, pavers, cranes and the MECHANICS who fix and maintain heavy equipment. We are also represent the SURVEYORS on these jobs.

What’s the starting rate for Apprentices?

Operators 60% Journeyman Rate

Mechanics 70% Journeyman Rate

How much does the training cost?

Any training you receive at the school is free, any cost for any State of Connecticut testing or licensing is at students expense (i.e. CDL permit fees, crane exam fees, hoisting licensing fee, etc)

Is there an application fee?

No

What’s on the aptitude test?

Mechanical Aptitude, Google online

Do you have study material for the aptitude test?

No we do not supply study material

How often do you come in for training after the 6 weeks?

Average 2 Saturdays a month and 2 nights a month

Can I apply if I have a criminal record?

Yes

Can I use my GI Bill benefits?

Yes if approved

Do I get paid for apprentice training?

No, you do not get paid for SRT while an apprentice.

As an apprentice, once you are placed with a contractor, you will begin to collect wages and benefits for OJT.

Why become an Operating Engineer?

Good Wages, Great Health Benefits, Pension, Career

Can I take training if I am not a member, or in a different union?

No.  Training is FREE TO MEMBERS of LOCAL 478 and selected apprentices.

 

Retiree Members

Health

What if I go to work for a non-union employer doing work covered by our Collective Bargaining Agreement?

Your Health Benefits will be terminated immediately and you will not be eligible for COBRA.  You will be prohibited from taking an Annuity Distribution. If you are receiving a pension, your Pension Benefit and any Retiree Health Benefits you may be receiving will be terminated. You will be ineligible for SUB, referral by the Local, and Training classes.

Under what circumstances may a Retired Member work in Covered Employment without jeopardizing his/her pension?

Retired Members who choose to pay dues and join the Active Retiree Organization may be referred to work in Covered Employment. Retirees between the ages of 55 and 61 may work up to 160 hours every other calendar quarter; retirees between the ages of 62 and 70½ may work up to 59½ hours per month; and retirees over age 70½ may work unlimited hours. These rules were designed to reduce the likelihood that retired Members would gain eligibility for Active Member Health Benefits to minimize the problems associated with a Member's eligibility, and flipping back and forth between the Retiree and Active Health Plans.

What if I am declared disabled by the Social Security Administration?

Contact the Health and Contributions departments of the Local 478 Fund Office immediately. You may qualify for a disability Pension and Retiree Health Benefits.

How do I find out if my claim has been paid?

You will receive an explanation of benefits statement from the Fund Office to show that a claim has either been paid or denied. You can also check your benefits information on the I-Site portal (IUOE Local 478 Benefit Funds (issisystems.com)), or by calling the Local 478 Fund Office and asking for the claims department. Remember, the Fund is required by law to have a fully executed HIPAA designation form before we can discuss claim-related issues involving participants who are 18 or older with other individuals, including parents and spouses.

Do I need a referral from my primary care doctor for medical services?

No, this plan does not require you to obtain a referral to receive medical benefits.

Can I get a second opinion on a diagnosis I am concerned about?

Yes, the Fund will cover a second opinion provided your physician submits the claim according to the Plan rules.

How do I find out if my doctor is in the Anthem Blue Cross and Blue Shield network?

Call Anthem at 1-800-810-2583, or go to their Web site at www.bcbs.com.

What is my death benefit?

For Active Members, the death benefit is $25,000. For accidental death, the benefit doubles to $50,000. If you are on our retiree plan, the death benefit is $5,000. This taxable benefit is paid to the beneficiary of your choice at the time of death and is fully taxable. 

Who is my death benefit beneficiary?

If you are not sure who your beneficiary is, contact the Fund Office. You can change your beneficiary at any time by completing the appropriate beneficiary form. 

Can I designate more than one beneficiary?

You can designate as many beneficiaries as you want. 

How do I add my spouse to the Health Plan?

Call the Health Fund Office to request the paperwork you must fill out to add your spouse to the Plan. Retirees, on retiree copay, have 60 days to notify the Fund Office of the marriage. You will be required to submit a copy of your marriage certificate and your spouse's Social Security number. We handle all participant information, including Social Security identification numbers, within strict guidelines with respect to privacy and security. 

Which insurance is primary when my spouse has insurance too?

The Fund would be the primary payer for you and the secondary payer for your spouse. If you have children, we follow the birthday rule to determine coordination of benefits between our Fund and the other carrier. The spouse whose birthday falls first within the year holds the primary insurance for the children. (If a Local 478 Member's birthday is February 15, and his spouse's birthday is August 15, the Member would hold the primary insurance for the children.) The year of birth is not considered. 

How do I add my newborn child?

Call the Local 478 Fund Office as soon as the child is born. You'll need to provide the baby's name and date of birth, and a copy of the long-form birth certificate. This should be done as soon as possible to avoid any delay in processing the newborn's claims. We will need the baby's Social Security number as soon as it is available in order to continue processing benefit payments. 

How long do you cover dependent children?

The Fund covers eligible dependents until the age of 26.  Dependent children who are declared disabled by the Social Security Administration may be covered indefinitely. You should notify the Fund Office if your child has a disability. We need each covered dependent's Social Security number in order to process his or her claims. 

 

How do I request medical and dental cards?

Once you become eligible for Health Benefits in our system, your medical and dental cards are automatically sent to you. One set of (2) cards will be sent for the family with the Member's name and ID. If you need additional medical cards, please contact the Health Fund office, if you need Dental cards please contact Delta Dental at 1-800-452-9310. 

Do I need a prior authorization for benefits?

The only time you need to obtain a prior authorization is before you receive in-patient hospital or Rehabilitation stays from Telligen by calling them at 1-833-374-9833. This requirement applies only to Active Members and Pre-Medicare Retiree participants. Members can contact the Health Fund Office for support or confirmation of authorization.

Am I eligible for vision benefits?

Adults are eligible for vision benefits once every two years, and children 12 and under are eligible once a year. If you are not sure when you last used your vision benefit, contact the Health Fund Office and ask for the claims department. 

What happens if I use a non-participating provider?

If you use a non-participating provider for dental, medical or vision visits, your claims will still be considered, but they will be paid at a different rate and may be subject to a deductible. For more information, contact the Fund Office.

How do I obtain prior authorization for behavioral health or substance abuse visits/hospitalization?

Contact Telligen at 1-833-374-9833.

How much is my prescription co-pay?

If you purchase your prescription at a pharmacy that participates with the OPTUMRx network, you will pay the following co-pays or the cost of the prescription: $15 for generic, $30 formulary, or $45 non-formulary for a 30-day supply. The co-pays for OPTUMRx order drugs are: $25 for generic, $55 for brand and $85 for brand (non-formulary). 

How do I obtain a formulary list?

Formulary lists are updated every three months. You can find the latest list at www.OPTUMRx.com, or by calling OPTUMRx at 855-295-9140. 

How do I submit a prescription claim for a refund?

If you purchased prescriptions on your own or have other insurance, you may submit a paper claim for a refund. You need to submit the prescription receipt with a prescription claim to OPTUMRx at the address provided on the back of the claim form. 

Annuity

What if I go to work for a non-union employer doing work covered by our Collective Bargaining Agreement?

Your Health Benefits will be terminated immediately and you will not be eligible for COBRA.  You will be prohibited from taking an Annuity Distribution. If you are receiving a pension, your Pension Benefit and any Retiree Health Benefits you may be receiving will be terminated. You will be ineligible for SUB, referral by the Local, and Training classes.

Pension

What if I go to work for a non-union employer doing work covered by our Collective Bargaining Agreement?

Your Health Benefits will be terminated immediately and you will not be eligible for COBRA.  You will be prohibited from taking an Annuity Distribution. If you are receiving a pension, your Pension Benefit and any Retiree Health Benefits you may be receiving will be terminated. You will be ineligible for SUB, referral by the Local, and Training classes.

Under what circumstances may a Retired Member work in Covered Employment without jeopardizing his/her pension?

Retired Members who choose to pay dues and join the Active Retiree Organization may be referred to work in Covered Employment. Retirees between the ages of 55 and 61 may work up to 160 hours every other calendar quarter; retirees between the ages of 62 and 70½ may work up to 59½ hours per month; and retirees over age 70½ may work unlimited hours. These rules were designed to reduce the likelihood that retired Members would gain eligibility for Active Member Health Benefits to minimize the problems associated with a Member's eligibility, and flipping back and forth between the Retiree and Active Health Plans.

When I retire, can I elect to pay dues as an Active Retiree?

In addition to being eligible to work under the Retiree Work Rules, joining the Active Retiree Organization permits you to participle in all of their events.

What if I am declared disabled by the Social Security Administration?

Contact the Health and Contributions departments of the Local 478 Fund Office immediately. You may qualify for a disability Pension and Retiree Health Benefits.

SUB

What if I go to work for a non-union employer doing work covered by our Collective Bargaining Agreement?

Your Health Benefits will be terminated immediately and you will not be eligible for COBRA.  You will be prohibited from taking an Annuity Distribution. If you are receiving a pension, your Pension Benefit and any Retiree Health Benefits you may be receiving will be terminated. You will be ineligible for SUB, referral by the Local, and Training classes.

As an active Retiree, may I collect SUB benefits?

No

Local 478

What is a union?


A union is a group of employees who join together within a company to bargain collectively for better wages, stronger benefits and safer working conditions. 

What do unions do?

A union’s primary objective is to secure good contracts for its members and to enforce the provisions of that contract. The union also administers some of the contract's important benefits directly. Often these include health plans, pensions and labor/management partnerships and trusts. 

What if I go to work for a non-union employer doing work covered by our Collective Bargaining Agreement?

Your Health Benefits will be terminated immediately and you will not be eligible for COBRA.  You will be prohibited from taking an Annuity Distribution. If you are receiving a pension, your Pension Benefit and any Retiree Health Benefits you may be receiving will be terminated. You will be ineligible for SUB, referral by the Local, and Training classes.

When I retire, can I elect to pay dues as an Active Retiree?

In addition to being eligible to work under the Retiree Work Rules, joining the Active Retiree Organization permits you to participle in all of their events.