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:
|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|
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.
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.
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.
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.
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:
Southwest Carpenters Health & Welfare
533 S. Fremont Avenue
Los Angeles, CA 90071
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.
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.
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|
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.
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.
The Active Plan is offered in all jurisdictions by Labor Agreement or to Non-Bargaining plan participants.
Active Plan Coverage Includes:
The Bronze Plan is offered as follows:
Bronze Coverage includes:
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.
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.
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.
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.
No. HMOs maintain a closed network, unless you have an emergency out of the service area.
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.
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.
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.
You will owe the specified co-pay amount per service.
The PPO plans are paired with prescription benefits through Express Scripts.
Medications are covered through the Kaiser network for those on the HMO.
The PPO plan will coordinate benefits according to which plan is "primary." See the SPD for details on the "Birthday Rule" for dependent coverage.
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.
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 you are in the first year of Apprenticeship.
|Type of Service||Independence Active PPO Co-Pay||Independence Bronze PPO
|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)
|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).|
|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|
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 can access care 24/7 through MDLive by visiting MDLIVE: Board-Certified Doctors on Call 24/7 or downloading the MDLive mobile app.
Kaiser Permanente Participants, go to the link below to sign up and get information on the Telemedicine Program:
|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/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.
|Type of Drug||Retail Network Pharmacy
(Up to a 30-Day Supply)
|Mail Order Pharmacy
|Generic||$10; $0 for prescription contraceptives||$20; $0 for prescription contraceptives|
UT, AZ, NM, CO
|Orthodontic - Child||50%||$1,500||50%|
|Orthodontic - Adult||50%||$1,500||50%|
|Calendar Year Max||$3,000||None||$5,000|
|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|
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)
Download the App: GuidanceNowSM
When you call or sign in through the App or Website, use the WEB ID: SWCCAP
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|