Southwest Carpenters Enrollment

Enrolling In Your Health Plan

Becoming Eligible

When you become eligible for benefits through the Southwest Carpenters Trust Health & Welfare Plan you will receive an Eligibility Packet in the mail.

It is important that your correct mailing address is on file with the Administrative Office so you can receive all of the important information you need.

You are eligible to enroll when you meet the eligibility requirements below:

Carpenter Active Eligibility

Calendar Work Quarter Hours Earned Eligibility Quarter
January, February, March May, June, July
April, May, June August, September, October
July, August, September November, December, January
October, November, December February, March, April

Non-Bargaining Eligibility

To the top
Your Eligibility Packet

Your Eligibility Packet

The packet you receive in the mail will contain the following items:

After reviewing your packet and making your health plan choices you must return the completed enrollment and required dependent forms to the Administrative Office for processing in the envelope provided.

Enrolling Dependents

You have 90 days to enroll your dependents and provide the required documents and enrollment forms. If you wait more than 90 days, coverage will begin on the first of the month in which all the required documents are provided.

To the top
Available Health Plan Options

Available Health Plan Options

Your Eligibility Packet will indicate the health plan choices that are available to you.

Your available health plan choices will depend on the following:

To the top
Choosing Your Health Plan

Choosing Your Health Plan

When you are choosing our health plan and adding dependents you should consider the following:

The Kaiser Health Maintenance Organizations (HMO) and the Anthem Preferred Provider Organizations (PPO) provide comprehensive medical coverage but under different structures.

How do I select a provider?

Anthem PPO

Preferred Providers are in-network providers who have agreed to a reduced fee schedule with Anthem.

You are free to choose any provider or to change providers without giving notice and no referral is needed to see a specialist.

Kaiser HMO (CA and CO only)

You will select a Primary Care Provider (PCP) through your HMO who will coordinate your care according to the rules of the plan, including specialist referrals.

To change your PCP you will have to contact your HMO plan and request a change.

Can I see providers outside of the network (Out -of-Network Providers)?

Anthem PPO

Yes, you have that freedom and flexibility to go out of network but you will be responsible for higher out of pocket costs including a higher deductible and co-insurance amount.

Kaiser HMO (CA and CO only)

No. HMOs maintain a closed network, unless you have an emergency out of the service area.

I have a dependent residing in another state (ex. College student).

Anthem PPO

Anthem maintains a nationwide network of providers and your dependents will likely be able to get care in other areas and stay in the network.

Kaiser HMO (CA and CO only)

The HMO will only cover services within a defined service area. If your dependent resides outside the service area the HMO may only cover verified emergency services.

Do I need permission or a referral to see a specialist?

Anthem PPO

No.

Kaiser HMO (CA and CO only)

Yes.

What do I pay to see a doctor?

Anthem PPO

Once your deductible is met, you will pay your coinsurance amount which is a percentage of the amount negotiated between the provider and Anthem.

Your annual deductible and co-insurance amount will depend on your PPO Plan.

Kaiser HMO (CA and CO only)

You will owe the specified copay amount after any deductible amount is paid.

How are medications covered?

Anthem PPO

The PPO plans are paired with prescription benefits through Express Scripts.

Kaiser HMO (CA and CO only)

Medications are covered through the Kaiser network for those on the HMO.

What if my family has other coverage?

Anthem PPO

The PPO plan will coordinate benefits according to which plan is "primary." See the SPD for details on the "Birthday Rule" for dependent coverage.

Kaiser HMO (CA and CO only)

The HMO is usually considered to be the primary plan, regardless of which participant is the primary member. An HMO plan will not coordinate benefits with other plans.

If I don’t like my current health plan can I change?

If you maintain your eligibility you can request to change your plan options for the next year during Open Enrollment which is held during November.

To the top
Your Medical Cost At A Glance

Your Medical Cost At A Glance

Information About the Anthem PPO Plans

Type of Service Anthem Platinum PPO Anthem Bronze PPO
(limited offering)
Preventative Care $0 $0
Annual Deductible $300 self / $900 family $3,000 self / $6,000 family
Physician Office Visits, Urgent Care, Hosital Visits, Surgery, Lab, X-ray 10% of the negotiated cost after the deductible is met. 20% of the negotiated cost after the deductible is met.
Emergency Room $250 plus 10% after the deductible is met. $250 plus 10% after the deductible is met.
LiveHealth Online $5.00 - no deductible $5.00 - no deductible
The examples are for in-network providers only. For coverage of out-of-network providers, see your Comparison of Benefits or the Summary Plan Description (SPD).

Information About the Kaiser Permanente HMO Plan
(Only in California and Colorado, Bronze Plan Excluded)

Type of Service Kaiser HMO
Preventative Care $0
Annual Deductible $300 self / $600 family hospitalization only
Physician Office Visits $10 Non-specialist $20 Specialist
Hospital Visits, Surgery, Emergency Room 10% of the negotiated cost after the deductible is met.
Lab, X-ray $10 (MRI, CT or PET scan $50)
To the top
Prescriptions

Prescriptions

Express Scripts
(Anthem Active and Bronze Participants)

Type of Drug Retail Network Pharmacy
(Up to a 30-Day Supply)
Mail Order Pharmacy
(31- to 90-Day Supply)
Generic $10; $0 for prescription contraceptives $25; $0 for prescription contraceptives
Preferred Brand $40 $100
Non-preferred Brand $60 $150
Specialty $50 $100
Preferred/Non-Preferred Brand For Which There is a Generic Equivalent Available You will be charged the brand copayment, plus the difference in cost between the brand and the generic You will be charged the brand copayment, plus the difference in cost between the brand and the generic

Kaiser
(Only in California and Colorado, Bronze Plan Excluded)

Type of Drug Retail Network Pharmacy
(Up to a 30-Day Supply)
Mail Order Pharmacy
(100-Day Supply)
Generic $10; $0 for prescription contraceptives $20; $0 for prescription contraceptives
Preferred Brand $30 $60
Specialty $30 Contact Kaiser
To the top
Dental

Dental

Information About the UnitedHealthcare Dental Plans
(Bronze Plan Excluded)

Service DPPO
All States
DC
CA/NV
INO
UT, AZ, NM, CO
Deductible $50/$150 $0 $0
Preventive $0 $0 $0
Filling 50% $5-$10 $5-$10
Porcelain Crown 50% $90 $90
Root Canal 50% $15-$60 $15-$60
Orthodontic - Child 50% $1,500 50%
Orthodontic - Adult 50% $1,500 50%
Calendar Year Max $2,000 None $5,000

For more information:

To the top
Vision

Vision Coverage
(Bronze Plan Excluded)

Your Cost at a Glance

Service Frequency Price
Exam Once Every 12 Month $10 Copay
Lenses-Per-Pair Once Every 12 Months, Frames-Once Every 24 Months $20 Copay for Materials
Contact Lenses Once Every 12 Months Instead of Frames and Lenses, at the $20 Copay, You May Select Contact Lenses
To the top
Life Insurance

Life Insurance

All actively eligible participants, are entitled to the following Life and Accidental Death and Dismemberment Insurance, regardless of medical plan choice or enrollment. COBRA participants are excluded.

Life Benefit AD&D Benefit
Participant $20,000 $5,000 - $20,000
Dependent (if enrolled) $3,000 $0

 MetLife Advantages Slipsheet

 Beneficiary Form

To the top
For More Information

For More Information

To the top