|What is my Insurance Carriers name?
||Your Insurance Plan name is:
So Cal Drug Benefit Fund Physical Address: 2220 Hyperion Ave Los Angeles Ca 90027
Mailing Address: PO BOX 27920 Los Angeles CA 90027
Phone Number: 1-323-666-8910
|When do I become eligible for benefits?
||Effective November 2012:
Initial eligibility for Clerks is established after 3 full months of employment which is to work Qualifying Hours in 2 consecutive months, skip 1 month, eligible on the first to the 4th month. After 6 months of eligibility, dependent coverage, dental and prescription benefits become available.
Initial eligibility for Pharmacists is established for family coverage with prescription benefits after 3 full months of employment which is to work Qualifying Hours in 2 consecutive months, skip 1 month, eligible on the first of the 4th month. After 6 months of eligibility, dental coverage will become available for all enrolled family members.
Ongoing eligibility for both Clerks and Pharmacists will not change, which is to work Qualifying Hours in 3 consecutive months (average/rolling 3 months), skip 2 months, eligible on the first of the next month.
|Am I under Gold or Platinum benefits? What is the difference?
||If you were hired on 11/01/1995 & thereafter with Rite-Aid, you are under Gold benefits. If you were hired on 07/01/1996 & thereafter with CVS, you are under Gold benefits.
All other members hired prior to the above noted dates, benefits are determined and reported by the Employer.
|How many hours do I need to work to keep my coverage?
||Once eligible, you must continue to work the Qualifying Hours during each month to maintain your eligibility, to establish for other benefits, and to establish and/or maintain eligibility for your Dependents. You are also required to pay monthly (weekly) contributions (also called “premiums”) in order to maintain coverage. Every Employers payroll period differentiates, contact the Insurance Department for details.
|How do I enroll myself or my dependents in Health coverage?
||When you work Qualifying Hours, the So Cal Drug Benefit will notify you via mail. New hires are allowed to “enroll/elect “coverage by returning an enrollment form within 120-days from the date they would have been eligible by virtue of hours. If payroll deductions begin after the date they would have been eligible of virtue of hours, and if the participant wants to enroll retro-active, the participant will need to pay the required employee contributions in order to be eligible for retro-active coverage.
Newly enrolled members are required to pay 2 months of premiums in advance by submitting a check payable to So Cal Drug Benefit Fund orwww.ufcwdrugtrust.org website under Self-payment option tab. If premiums are not paid in advance, the Fund will enroll you but eligibility will not take effect until payment is made.Double deductions are not an Option.
Note: The member must list/include all dependents on their initial enrollment form that they wish to receive benefits with copies of recorded birth certificates, marriage certificate, and Declaration of Domestic Partnership form to be added when eligible.
Enrolled Domestic Partners will have additional costs due to Federal IRS guidelines. Contact the SO CAL DRUG BENEFIT FUND @ 1-323-666-8910 for further assistance.
Anthem Blue Cross PPO is the only medical option for the first 4 open enrollments.
|How much do I have to pay for my Health & Welfare coverage?
|All Members are required to pay premiums toward the cost of coverage. These premiums (Also called “Employee Contributions”) will be paid via payroll deduction.
Emp-only coverage $7 weekly/$30.33 monthly.
Emp plus one or more children $11 weekly/$47.67 monthly.
Emp plus Spouse, Domestic Partner with/without children $15 weekly/$65 monthly.
|Do I have to elect/enroll in the coverage at the time offered? Can I enroll at any time onto the Plan?
|No, you may decline the coverage by checking the “reject coverage box” on the enrollment form.
Members who declined coverage and who withdrew their dependent will be allowed to elect coverage, or enroll their dropped dependent during the annual Open Enrollment period, or following a Special Enrollment right.
Special Enrollment Rights are available outside of Open Enrollment for two situations. You have 120 calendar days from the Life Event occurred to add a newly acquired spouse, baby or in the event a Loss of Coverage from other Health Coverage. Contact Insurance Department immediately
|How long can my dependent children be covered or remain on my plan?
|Coverage for children (except Foster children) under All Active Plans is available up to age 26 providing that the participant includes/enrolls that dependent on their enrollment form.
Children under the Retiree plan and all Foster children are covered under old rules; requires full-time student status and up to age 24.
|If I Transfer from another Trust Fund or Union Local, what steps should I take?
|You must contact the Insurance Department within 60 days after the start of employment from the jurisdiction of one participating UFCW Health and Welfare Fund to another. A Transferred Eligibility and Enrollment forms must be completed to determine continuous eligibility with the Trust Fund.
Those continuing to work with the same company in the So Cal UFCW areas transferring from one Union Local to another please contact the Union Office you’re transferring to verify your address and telephone number if any changes need to be made ASAP.
|What if I change Employers, do I need to contact the Insurance or the Union Local Membership departments?
||Yes. For the Insurance dept. when changing employers within 120 days, you need to fill out a new enrollment form with a premium authorization form (if applicable) so we can start premium deductions with the new employer. If you’re past the 120 days and returning back into the Industry from terminating employment, you will be considered a New Hire.
|Can I change my Medical/Dental coverage at any time and if not, When?
Open Enrollment is held once a year for a January 1 effective date with a deadline date of December 31 no later to change plans. Participants can add and delete dependents or dis-enrollment from their Insurance coverage.
Outside of open enrollment, members can use a once in a lifetime medical or dental plan change. Members may dis-enroll from the plan or delete dependents with a letter in writing effective the first of the next month following receipt of letter or specified declined date.
Newly hired members, starting with the fourth (4th) Open Enrollment after your hire date, the HMO medical plans will become available to you.
|Are there pre-paid (HMO) medical plans available?
||Kaiser DHMO and United HealthCare Flex plans are available to newly acquired members after the 4th Open Enrollment.
|What dental plans are offered to me?
||There are two (2) plans to choose from: Delta Dental of California, a PPO or United Concordia, a DHMO. If you do not choose a dental plan at the time of initial enrollment, you will automatically be assigned to Delta Dental. See summary plan for maximums and deductibles
|My spouse’s employer offers Health coverage, does he have to take their coverage or can we decline it?
||For married Employees and Employees with Domestic Partners (the use of the term “spouse” in this section includes Domestic Partners): If your spouse’s employer offers health care coverage, your spouse must enroll in that employer’s coverage that is comparable to your coverage under this Fund, even if your spouse is required to contribute toward the cost of that coverage.
If your spouse’s employer does not offer coverage that is comparable to your coverage from the Fund, your spouse must enroll in the best coverage available through his/her employer. If your spouse is eligible for medical, prescription drug, and/or vision benefits through his or her employer but fails to enroll, this Plan will pay only 40% of its normal benefits (i.e. this Plan will reduce its payment amount by 60%) under the Indemnity Medical Plan, Prescription Drug Plan and /or Indemnity Dental Plan.
This rule does not apply if both spouses are eligible for coverage as Employees of contributing Employers and one spouse has elected coverage for “Employee plus spouse or Domestic Partner” as listed above. Please contact the Fund Office for more information.
|I have not received a Medical Card, Dental Card or Prescription Card yet. Who do I contact?
||Anthem Blue Cross Providers: www.Anthem.com/Ca or 1-800-227-3641
Optum Rx (prescriptions): 1-800-788-7871 for Q&A on RX costs.
All other Plans can call or order via on-line medical ID cards and view the Plan Summary, below:
Kaiser Members: www.kp.org or 1-800-464-4000
United HealthCare Members: www.MYUHC.com or 1-800-624-8822
United Concordia: www.unitedconcordia.com or 1-866-357-3304
Delta Dental of Calif: www.deltadentalins.com or 1-800-765-6003
If eligibility problems, contact the Insurance Department ASAP
|Notice of Self-Pay, Cobra Continuation Coverage and HIPAA Letter
||If you don’t work Qualifying Hours, you may continue coverage by paying the self-payment premium set by the Fund. You will receive a self-pay billing notice and may pay up to 3 months of self-payments while you are on maternity, disability and worker’s compensation. If you work Qualifying Hours in the month after the month for which you make a self-payment, your coverage will begin again as of the first day of the third (3) following month. If short Employee-Contributions, you will be billed the month prior to losing coverage. Please note the deadline dates on all self-pay billings.
Members will receive a COBRA notice with Loss of Coverage Letter if they are short hours or have terminated employment. If a member quits or terminates, coverage will remain in effect through the end of the month of termination. Members may continue coverage by completing the Cobra application and return it with payment before the deadline given.
If on State Disability, Workers Comp or FMLA/CFRA, All Members must submit a Supplementary Application form, employer approval letter (LOA, FMLA) and submit copies of all check stubs (Workers Comp or Disability) and submit employee contributions. Each day paid is a credit of 6 hours for insurance eligibility purposes.
Contact the Insurance Department for further instructions.
FOR ALL PENSION & RETIREE MEDICAL QUESTIONS, PLEASE CONTACT THE SO CAL DRUG BENEFIT FUND AS THE UNION LOCAL SATELLITE OFFICES HAVE NO ACCESS TO YOUR PENSION BENEFIT INFORMATION
1-323-666-8910 ext 500