QUESTIONS |
ANSWERS |
|
What is my Insurance Classification?
Plan A |
If you work for Albertsons, Ralphs, Staters or Vons (Plan A) and were hired prior to March 1, 2004 you are a Platinum +. If you were hired after that date you are a Silver, Gold or Platinum member |
Plan B |
If you work for Food-4-Less or Luckys (Plan B) and were hired prior to October 1, 2004 you are a B Platinum +. If you were hired after that date you are a Silver, Gold or Platinum member. |
What is the difference between a Silver, Gold or Platinum member? |
A Silver member is a Clerk’s Helper or Utility Clerk. Any other classification who has less than 3 ½ years of employment is also A Silver member. Any other classification who has at least 42 months of employment is a Gold member. A Platinum member is any other classification that if hired prior to July 22, 2007 and has at least 5 ½ years employment or if hired after July 22, 2007 and has at least 6 ½ years employment. |
When do I become eligible for benefits? |
Silver members under Plan A, other than Clerk’s Helpers, hired after March 1, 2004, or under Plan B, other than Utility clerks, hired after October 1, 2004 will be eligible for employee-only or employee-child coverage on the first day of the calendar month following the employees 6th month of employment. Clerk’s Helpers and Utility Clerks will be eligible for employee-only coverage on the 1st day of the calendar month following the employee’s 18th month of employment. |
What family members are covered? |
Spouses, Registered Domestic Partners, unmarried children, stepchildren, some foster children and legally adopted children under age 19 years of age. Unmarried children as above who are 19 through 24 and full-time students with Student Certification on file. Foster children must be enrolled for five years prior to attaining age 19 to be covered as full-time students. Unmarried dependent children who are covered and become disabled due to physical or mental handicap while covered can remain covered permanently or until recovered. |
How many hours a month do I have to work for benefits? |
Clerk’s Helpers and Utility Clerks have to work 64 hours per month. Meat Cutters and Grandfathered Meat Wrappers need 76 hours per month. All other Plan B workers also need 76 hours per month. All other Plan A workers need 92 hours per month. |
What is a month? The first to the end or is it different since our pay periods are different? |
The hours you work in a week are credited to you as of each Sunday, based on the standard Industry workweek, which is Monday through Sunday. Your monthly hours are credited to you as of the last Sunday of each month. see calendar |
Can I change coverage and if so, when? |
Open Enrollment is held once a year and takes effect in January of the following year. Platinum + members can change plans then. Once every five years, Platinum + members can also change outside of Open Enrollment. Open Enrollment is when all other members, Silver , Gold or Platinum can add or delete coverage. Silver, Gold & Platinum members can not change coverage to a different plan. |
Are there pre-paid (HMO) medical plans available?
|
Kaiser and PacifiCare are available to Platinum + members only. |
If a claim is denied, how do I appeal? |
I.If a service is denied, you will be notified in writing and there is a specific time frame and forms to be followed and used. Call the insurance department to request the form and ask any questions you may have. |
Please clarify Student Coverage. |
Students are covered from age 19 through the month of their 24th birthday provided they are unmarried and attending an accredited school full-time. A completed Student Certification, signed by the member and School Register, must be on file each quarter or semester. To cover the summer months, the member must complete and sign a Student Certification Of Intent To Return To School After Summer Recess each year. |
I have to have suregery, what should I do? |
Under The Indemnity Medical Plan use a contracting hospital or outpatient facility and have your doctor call for approval at 1-800-274-7767 BEFORE you go in. Kaiser and PacifiCare: See your plan provider. |
Which months are non-qualifying? |
There are none. Eligibility is based on a skip-month basis; hours worked in January provide coverage in March, February in April, etc. |
I have not received a medical card yet. Why? |
Indemnity Medical Plan members receive a medical id card and use providers from a directory of approved providers. It takes about a month after you become eligible to receive a card. if you need help, you may call your medical plan’s 800#.
Anthem Blue Cross, Group 57D72A, 1-800-825-1030
PacifiCare, Group 737, 1-800-624-8822
Kaiser, Group 1500, 1-800-464-4000. |
Billings to members who are short hours for medical coverage |
Members will receive a COBRA notice if they are short hours or no longer working. If a member wishes to continue coverage by obtaining COBRA they must complete the application and return it beofre the deadline given. If a member was short hours due to a paid vacation or disability, contact the insurance department for an Application for Reinstatement of Eligibility. Platinum + members should complete the vacation portion or if on State Disability or Workman’s Compensation, that section, and return with copies of all stubs from State or Work Comp. Silver, Gold & Platinum can not use State Disability or Workman’s Compensation to maintain coverage, they must lose coverage or elect COBRA. |
If I quit or get terminated, how long will my coverage last. |
If you terminate your employment or are terminated by your employer, your coverage will remain in effect only through the end of the month of the termination, provided you are eligible. You may continue coverage through COBRA. |
This information has been
written as clearly and accurately as possible. You should be aware,
however, that benefits are governed by master policies,
contracts and Plan documents. In all cases
of benefit determination or differences of opinion,
the legal policies, contracts or Plan documents will
prevail.
You can examine the master
policies, contracts and Plan documents by contacting
the Fund Office. If
you prefer, you can request, in writing, copies of
these documents for a reasonable fee. The Fund
Office will send you the documents within 30 days
of receiving your request.
The Fund maintains the Health
Care Plan for the exclusive benefit of eligible
employees; however, eligibility for or participation
in the Health Care Plan is not an assurance or
guarantee of continued employment.
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