Southwest Carpenters Health And Welfare

Enrolling In Your Health Plan

Eligibility for Healthcare Coverage

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 to receive all important information you may need.

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

Active Carpenter 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

Reserve Bank

Disability

If you become disabled and are unable to work, you may be eligible to continue your health coverage with Disability Hours Credit. You must submit your Disability Hours Claim Form within 120 days of the date of your disability. Other rules may apply.

See https://lifeevents.carpenterssw.org/#disability for information and the claim form.

Hours Buy Back

Participants who lose eligibility due to a lack of reported work hours, or reserve bank hours, have the option to self-pay the total amount of contributions needed to meet the minimum number of reported hours to maintain eligibility for one quarter.

The following conditions apply:

If you qualify for the Hours Buy Back, a letter will be sent to your address on file with information regarding the number of hours required to keep eligibility for the next quarter, as well as the amount due.

Non-Bargaining Eligibility

COBRA Continuation

COBRA, a federal law, allows covered participants and their dependents to continue health care coverage for a limited period at their own expense under certain circumstances when health coverage would otherwise end under the terms of the Plan because of a qualifying event.

See https://lifeevents.carpenterssw.org/#cobra for additional details.

Military Service Credit

If you are absent from employment due to Military Service, you may be entitled to continue your Health Coverage under the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA).

See https://lifeevents.carpenterssw.org/#military for additional details.

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Plan Enrollment

Plan Enrollment

When you become eligible for health coverage for the first time, you will receive a First Time Eligible Packet in the mail with plan information, required notices, authorization forms and enrollment forms.

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.

If you are unable to print plan or enrollment documents as needed, you may Submit a Request for documents to be mailed to you.

Submit your completed forms via email to HWEnrollment@carpenterssw.org or by mail to:

Attn: Enrollment
Southwest Carpenters Health & Welfare
533 S. Fremont Avenue
Los Angeles, CA 90071

Enrolled Participants - Making Plan Changes

Active Plan Changes

Once enrolled, you are permitted to choose a different medical or dental plan at any time, as long as you have been enrolled on your current plan choice for a minimum of one year, by completing and returning a new enrollment form indicating your plan choice.

See Choosing your Health Plan or download Health Plan Benefits at a Glance for information regarding the medical and dental plans available in your area.

Bronze Plan Changes

If you work under a Labor Agreement in Arizona, Colorado, Utah, or New Mexico and have the option to choose the Independence Bronze Plan or the Independence Active Plan, you are now permitted to change your plan at any time as long as 12 or more months have passed since your last medical plan change.

If the plan change will affect your base pay rate according to the governing labor agreement, your base pay rate change and your plan change will be effective on the same day.

Plan Change Effective Dates

Changes are effective on the 1st day of the 3rd calendar month after the enrollment form is received.

Month Form Received Plan Change Effective Date
January April 1st
February May 1st
March June 1st
April July 1st
May August 1st
June September 1st
July October 1st
August November 1st
September December 1st
October January 1st
November February 1st
December March 1st

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. The required documents are:

When you become eligible for health coverage for the first time you will receive a First Time Eligible Packet in the mail with plan information, required notices, authorization forms and enrollment forms.

To add or remove an enrolled dependent, see https://lifeevents.carpenterssw.org/#dependents for more information.

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Health Plan Options

Health Plan Options

See Choosing Your Health Plan or download Health Plan Benefits at a Glance for information regarding the medical and dental plans available in your area.

Active Plan Coverage

The Active Plan is offered in all jurisdictions by Labor Agreement or to Non-Bargaining plan participants.

Active Plan Coverage Includes:

Bronze Plan Coverage

The Bronze Plan is offered as follows:

Bronze Coverage includes:

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 Independence Preferred Provider Organizations (PPO) provide comprehensive medical coverage but under different structures.

How do I select a provider?

Independence PPO

An In-Network Provider has agreed to accept a reduced fee for health care services to become part of the Independence PPO network.

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

Go to myibxtpabenefits.com to view the provider network. Enter the prefix EFW to search.

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)?

Independence 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 $500 deductible for the Active Plan and a $10,000 deductible for the Bronze Plan and 50% of the allowable charge.

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).

Independence PPO

Independence 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?

Independence PPO

No.

Kaiser HMO (CA and CO only)

Yes.

What do I pay to see a doctor?

Independence PPO

For the Active Plan, you will pay a specific co-pay amount per service with no annual deductible.

For the Bronze Plan, once your deductible is met, you will pay your coinsurance amount which is a percentage of the amount negotiated between the provider and Independence.

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

Kaiser HMO (CA and CO only)

You will owe the specified co-pay amount per service.

How are medications covered?

Independence 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?

Independence 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?

You can change your medical or dental plan at any time as long as you have been enrolled on your current plan for 1 year unless your are in the first year of Apprenticeship.

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Your Medical Cost At A Glance

Your Medical Cost At A Glance

Information About the Independence PPO Plans

Type of Service Independence Active PPO Co-Pay Independence Bronze PPO
(limited offering)
Preventative Care $0 $0
Annual Deductible N/A $3,000 self / $6,000 family
Office Visit/Specialist $15/$30 per visit N/A
Diagnostic X-Ray or Lab $30 per visit N/A
Chiropractor $15 per visit
(Limit 24 visits per year)
N/A
Physician Office Visits, Urgent Care, Hospital Visits, Surgery, Lab, X-ray N/A 20% of the negotiated cost after the deductible is met.
Hospital Admission $500 per admission N/A
Outpatient Surgery $250 per surgery N/A
Emergency Room $250 per visit $250 plus 10% after the deductible is met.
Urgent Care $100 per visit N/A
MDLIVE $5.00 per visit $5.00 - no deductible
The examples are for in-network providers only. For coverage of out-of-network providers, see your 2021 Health Plan Benefits "At a Glance", the Summary Plan Description (SPD) or the Summary of Benefits and Coverage (SBC).

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

Type of Service Kaiser HMO Co-Pay
Office Visit/Specialist $15/$30 per visit
Diagnostic X-ray/Lab $10/$0 per visit
Chiropractor $15 per visit – limit 20 visits per year
Hospital Admission $500 per admission
Outpatient Surgery $250 per procedure
Emergency Room $250 per visit
Urgent Care $15 per visit
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Virtual Office Visits

Virtual Office Visits

The Independence and Kaiser plan options include Virtual Office Visits. This can be a convenient choice to avoid an Urgent Care visit for common minor medical conditions. They also offer psychological counseling with licensed providers.

Independence Participants

Independence Participants can access care 24/7 through MDLive by visiting MDLIVE: Board-Certified Doctors on Call 24/7 or downloading the MDLive mobile app.

Kaiser Participants

Kaiser Permanente Participants, go to the link below to sign up and get information on the Telemedicine Program:

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Prescriptions

Prescriptions

Express Scripts
(Independence Active and Bronze Participants)

Type of Drug Retail Network Pharmacy
(Up to a 30-Day Supply)
Mail Order Home Delivery
or CVS Smart 90
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

Routine maintenance medications are covered for a 30-day supply for only 2 fills. After the 2nd fill, you will pay the retail price for the medication unless you use the mail order pharmacy or visit a CVS Pharmacy for the Smart90 program to purchase a 90-day supply.

Express Scripts can help you arrange for at home delivery or locate a pharmacy.

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
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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 $3,000 None $5,000

For more information:

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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
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Reach Out For Help

Reach Out For Help

Your ComPsych® Carpenters Assistance Program (CCAP)

The CCAP is a free, confidential program, available 24/7/365 to all eligible participants and family members who may be overwhelmed by life's challenges.

Call: 1-833-792-2271 (833.SWCCAP1)

Website: guidanceresources.com

Download the App: GuidanceNowSM

When you call or sign in through the App or Website, use the WEB ID: SWCCAP

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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

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For More Information

For More Information

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