|What is my Insurance Carriers name?
||Your Insurance Plan name is:
UFCW Benefit Fund
6425 Katella Ave Cypress CA 90630
Mailing Address: PO Box 6010 Cypress Ca, 90630
Office Phone: 1-714-220-2297
|What is my Insurance Classification?
||Plan A: If you work for Albertsons, Ralphs, Vons, Stater Bros or Gelsons. (Plan A) and were hired prior to March 1, 2004 you are a Platinum +.
If you were hired after that date you are a A-110 Silver, Gold, or Platinum Member.
Pharmacists hired prior to September 9, 2011 are a Platinum +. Pharmacists hired after that are A-110 Platinum.
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 B-110 Silver, Gold or Platinum member.
|What is the difference between a Silver, Gold or Platinum member?
||A Silver member is a Clerk’s helper, Utility Clerk or any other classification that has less than 3 ½ years of employment.
A Gold member is one who has at least 3 1/2 months of employment.
A Platinum member is one hired prior to July 22, 2007 and has at least 5 ½ years employment or if hired after July 22, 2007 and as at least 6 ½ years employment.
The Trust Fund will notify you via mail of your “Step-Up Benefits” when applicable.
|When do I become eligible for benefits?
||New Hire Employees (except Clerk’s Helpers and Utility Clerks) will become eligible beginning the first day of the calendar month following their 6th month of employment.
Required hours must be worked in the 5th month for initial coverage in the 7th month.
New Hire Clerk’s Helpers will become eligible for employee & child coverage beginning the first day of the calendar month following their 18th month of employment. Required hours must be worked in the 17th month for coverage in the 19th month.
|How many hours a month do I have to work for benefits?
||Clerk’s helpers and Utility Clerks (F4L) need 64 hours per month.
Meat Cutters, Meat Wrappers and all Plan B (F4L) Clerks need 76 hours per month.
Plan A workers need 92 hours per month Sufficient hours worked on a skip month basis with payroll deductions taken in the same month worked determines your eligibility. Premium Schedule
|What is a work month and does is it start the first to the end or is it different since our pay periods are different? Which months are non-qualifying?
|The Standard Industry workweek is Monday through Sunday. Your monthly hours are credited to you as of the last Sunday of each month. See Calendar
Every month is a qualifying month. Eligibility is based on a skip-month; Example: Hours worked in January provides coverage in March, February for April, etc.
|What family members are covered?
|Spouses, Registered Domestic Partners, children, stepchildren, some foster children and legally adopted children under age 19 years of age.Enrolled Domestic Partners will have additional costs due to Federal IRS guidelines. Spouce can't be added untill the 25th month (Except Coutrtesy Clerks and Utility Clerks).
Unmarried dependent children who are covered and become disabled due to physical or mental handicap while covered can remain covered permanently or until recovered.
|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 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.
|What if I’m Military Active Duty or Reserves?
||A Verification of Military Service form must be filled out. Contact the Insurance Department for additional information.
|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.
Plan A & B Platinum + and Retiree members can change medical plans then.
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.
|Are there pre-paid (HMO) medical plans available?
||Kaiser and United Healthcare are available to A & B Platinum + Members only.
|I have not received a Medical Card or Prescription Card yet. Why and who do I contact?
||You will receive a medical ID card within 4-6 business days from the time enrolled in the plan. If you haven’t received an Anthem Blue Cross or Optum Rx card, please contact the Insurance Department for a replacement.
Anthem Blue Cross Providers:
www.Anthem.com/Ca or call 1-800-688-3828.
For Prescriptions visit OptumRx or call 1-888-715-7573 for Q&A on RX costs/exception requests.
Kaiser and United Healthcare members may call or order via Online medical ID cards and view the Plan Summary, See contact info below:
Kaiser Members: www.kp.org or 1-800-464-4000
United Healthcare Members: www.MYUHC.com or 1-800-624-8822
If you experience eligibility problems, contact the Insurance Department ASAP.
|If a claim is denied, how do I appeal?
||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.
|I need surgery, 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 United Health Care: See your plan provider.
|My spouse’s employer offers Health coverage, does he have to take their coverage or can we decline it?
||The Fund requires that if your spouse or domestic partner is eligible for medical, prescription, drug, dental, vision, chiropractor or other health care coverage through his or her own employment, he or she must enroll in that employer’s best plans whether or not enrollment requires payment of a premium.
The rule is extremely important because non-compliance could affect the amount of your spouse’s or domestic partner’s benefits. If your spouse does not enroll in his or her employer’s plan, benefits under the Fund’s plans will be paid assuming that your spouse or domestic partner is enrolled in his or her own employer’s best plan. If not enrolled for all health care benefits available through his or her employer, in its best plan, benefits under the Fund’s plans will be reduced by 60%. In other words, the Fund’s Plans will pay only 40% of covered charges.
The Fund’s health care plans coordinate with other employer’s health care plans to ensure that those other plans share some of the cost of benefits for working families. Coverage for dependent children is not affected; only your spouse or domestic partner is required to be enrolled in the group coverage when available.
NOTE: If your spouse or domestic partner is not working now but becomes eligible for coverage through an employer in the future, he or she must enroll in the employer’s best plan immediately upon becoming eligible. In addition, if there is a change in your spouse’s or domestic partner’s health care coverage, you must notify the Fund Office immediately.