Choice of Hospital-Medical Plans
Both hospital-medical plan options (the Direct Payment and Kaiser Permanente Plans) provide coverage for no-cost Preventive Care Services mandated by the new health care law.
Under the Direct Payment Plan, “no cost” applies only when you obtain covered Preventive Care Services from a Participating Provider that is part of the Fund’s Preferred Provider Plan network or from a pharmacy that contracts with the Fund’s Pharmacy Benefit Manager (PBM), OptumRx. If you select the Kaiser Permanente Plan as your plan of choice, “no-cost” only applies when you obtain covered Preventive Care Services from a Kaiser Permanente Plan facility in Northern California.
For a complete list of no-cost Preventive Care Services, visit this website: www.healthcare.gov/preventive-care-benefits.
Hospital-Medical Plan Options
You should carefully review the Comparison of Benefit Plans, the SPD, and if needed, the official Plan Rules and Regulations and the Kaiser Permanente EOC to see which hospital-medical plan will meet the health care needs of you and your eligible Dependents.
If you decide to change plans, you must complete a Plan Application Form.
If you are a Retired Participant or the Dependent of a Retired Participant who is Eligible for Medicare and you have selected the Kaiser Permanente Plan, in addition to the Cement Masons Retired Plan Application Form, you must also complete a Kaiser Permanente Senior Advantage (KPSA) Election Form. By signing the KPSA Election Form, you are assigning your right to Medicare benefits to Kaiser Permanente—this type of plan is called a “Medicare Advantage” plan or Medicare Part “C”. If you later change to the Direct Payment Plan or you select another health plan outside of the Fund, you must complete a KPSA Disenrollment Form to release your Medicare benefits from Kaiser Permanente.
Anthem Blue Cross of California
1 888 245-5005
https://www.anthem.com/ca
Kaiser Permanente
1 800 464-4000
1 800 788-0616 (Spanish)
https://thrive.kaiserpermanente.org/
When You Can Change Hospital-Medical Plans
You are free to change your hospital-medical plan up to two times in a calendar year.
CAUTION: Any Plan Year Deductible satisfied, or cost sharing expenses applied under one plan will not count towards the Deductible and/or cost sharing limits of the new plan.
Before you change plans, you may want to consider making your plan change effective with the beginning of a new Plan Year. This means that any Plan Application Form would need to be at the Trust Fund Office no later than December 15th for a January 1st effective date for the change. Once your Plan Application Form has been processed by the Trust Fund Office, you will be notified in writing, confirming the plan and the effective date of the change.
Choice of Dental Plans
When you are eligible for hospital-medical benefits, regardless of which plan you choose, you are also eligible to participate in one of the Fund’s three dental plans. Whichever dental plan option you choose as the Participant, your Dependents must be enrolled in the same plan.
Dental coverage is automatic under the self-funded Delta Dental plan. You can change that plan if you do so within 60 days of first becoming eligible as an Active Participant otherwise you can change your dental plan only during Open Enrollment.
Retired Participants (Retirees may not enroll in a dental plan without a hospital-medical plan)
Dental benefits are optional and are available at an additional cost. If you are a Retired Participant and you enroll for the optional dental coverage, you must keep this coverage for a minimum of 36 months. If you cancel the dental coverage before 36 months, you will also be cancelling your hospital-medical plan (and the vision plan if you have enrolled for that optional benefit). If you are unsure whether you have met the 36-month provision, call the Trust Fund Office for assistance. NOTE: If you do not enroll in the dental plan when it is first offered to you or you cancel it after 36 months, you may not be given the opportunity to enroll at a later date. The Open Enrollment period is only for changing dental plans and not for enrolling if you originally declined the coverage or you cancelled your coverage after 36 months.
COBRA Qualified Beneficiaries
In order to have dental coverage, you must select the Core Plus Package when you first enroll for COBRA Continuation Coverage. The COBRA Core Plus Package includes the dental and vision coverage. You cannot select one without the other and there is an additional cost for these benefits. If you are a COBRA Qualified Beneficiary, you may not have the dental and vision option without a hospital-medical plan.
Dental Benefit Plan Options
1. Delta Dental is the Fund’s self-funded dental plan administered by Delta Dental of California. Orthodontic services are not covered under the Delta Dental Plan.
For a complete description, Continue Reading.
Delta Dental
1 800 765-6003
2. DeltaCare USA is a fully insured pre-paid Dental Health Maintenance Organization (DHMO). Under this type of plan, you must pre-select your dental office or dentist from a list of participating dental providers. Orthodontics are covered under the DeltaCare USA plan with a referral by your DentalCare USA dentist and approved by DeltaCare USA. You must only use a DeltaCare USA contracting orthodontist.
For a complete description, Continue Reading.
DeltaCare USA
1 800 422-4234
3. UnitedHealthcare Dental is a fully insured pre-paid DHMO. Under this type of plan, you can use only
“in-network” dentists. To locate a “in-network” dentist, visit the UnitedHealthcare Dental website and click “Find a Dentist”. A “in-network” dentist is one that participates the UnitedHealthcare Dental “CA Select Managed Care Direct Compensation” plan. You do not need to “pre-select” a dentist, but you must always use an “in-network” dentist. Dentists are available only in California. Orthodontics are covered under the UnitedHealthcare Dental plan with a referral by your UnitedHealthcare dentist. You must always user an “in-network” orthodontist contracting under the “CA Select Managed Care Direct Compensation” plan.
For a complete description, Continue Reading
UnitedHealthcare Dental
1 800 999-3367
Vision benefits are available through the Direct Payment and Kaiser Permanente Plans. This is an optional benefit for Retired Participants and COBRA Qualified Beneficiaries.
You should carefully read the VSP summary of benefits, exclusions and limitations before you obtain vision services. Some vision services and optical supplies may not be covered by the plan. If you choose to have vision or optical services that are not covered by the plan, you will be fully responsible for payment of any charges for those services.
The Vision Service Plan (VSP) Copayments are shown on the Comparison of Benefit Plans.
For a complete description, Continue Reading.
1 800 877-7195
Active Participant
You are automatically enrolled in the VSP plan regardless of hospital-medical plan in which you are enrolled.
Retired Participants
The VSP is an optional benefit choice available to you and your eligible Dependents at an additional cost. If you choose to enroll in the optional VSP, you must keep it for a minimum of 36 months. If you cancel the VSP before 36 months, you will also be cancelling your hospital-medical plan (and optional dental plan if you have enrolled for that coverage). If you are unsure whether you have met the 36-month provision, call the Trust Fund Office for assistance. NOTE: If you do not elect the optional VSP coverage when it is first offered to you or you cancel it after 36 months, you will not be given an opportunity to enroll at a later date.
COBRA Qualified Beneficiaries
In order to have VSP benefits, you will be required to select the Core Plus Package when you first enroll for COBRA Continuation Coverage. The COBRA Core Plus Package includes a dental plan and VSP for an additional cost. If you are a COBRA Qualified Beneficiary, you cannot have the dental and vision option without a hospital-medical plan.
Kaiser Permanente Plan Members
You have vision examination benefit as part of the hospital-medical plan. You can choose to use the vision examination benefit through Kaiser Permanente or through VSP.
If you or your Dependents choose to use a Kaiser Permanente Plan provider for the eye examination and you need glasses or contact lenses, while they can be purchased through Kaiser Permanente, you would be required to pay the full cost for the glasses or contact lenses and then file a Claim with VSP for reimbursement in accordance with Plan benefits. You can request a Claim form from VSP or download one from the VSP website.
Regardless of which hospital-medical plan you have chosen as an Active Participant, you will also be entitled to Death and Accidental Death and Dismemberment Benefits (Direct Pay and Kaiser Permanented Plans). Eligible Dependents also have a Death Benefit.
Death Benefit for Active Participants
If you die while eligible as an Active Participant or within 31 days from the loss of your eligibility as an Active Participant, your designated beneficiary will receive a Death Benefit in the amount of $10,000. Your beneficiary or authorized representative must notify the Trust Fund Office of your death and the beneficiary must provide a copy of the death certificate and complete an Employee Proof of Death form.
Extended Death Benefits for Former Active Participants
Accidental Death Benefits for Active Participants
Dismemberment Benefits for Active Participants
Limitations for the Accidental Death and Dismemberment Benefits
No more than $10,000 is payable for any one accident that results in accidental death and/or dismemberment.
Exclusions for the Accidental Death and Dismemberment Benefits
Death Benefits for Dependents of Active Participants
Eligible Spouse $5,000
Dependent Children
· 6 months to 26 years $500
· 24 hours to 6 months $100
Naming Your Beneficiary
You are free to name any person(s) as your beneficiary on a form approved by the Board. Generally, you will designate your beneficiary in the Enrollment Form.
You are free to change your beneficiary at any time. If you do not designate a beneficiary or your designated beneficiary is no longer living at the time of your death, any death benefits due, including, when applicable, the Accidental Death benefit, will be paid to your spouse. If you have no spouse, benefits will be paid to your surviving relatives in the following order: your child(ren), if none, your mother and father, if none, your brothers and sisters. If none of these family members survive you, the benefit will be paid to your estate.
The Trust Fund will only pay benefits to the beneficiary listed on the Board approved form and on file with the Fund prior to the date of death.
It is important that you keep your beneficiary designation up-to-date, especially if you have named a spouse and later divorce.
Prescription Drug Benefits for Active Participants
Active and Retired Participants that are enrolled in either the Direct Pay Medical Plan or the Kaiser HMO Plan are eligible for prescription drug benefits provided through the Fund’s contracting Pharmacy Benefit Manager (PBM) OptumRx or Kaiser Permanente.
OptumRx contracts with various retail pharmacies throughout the United States. Most large chain pharmacies are in the OptumRx network.
You can contact OptumRx directly for information about participating pharmacies, mail-order prescriptions and order refills at:
Toll-Free 1-888-245-5005
You can contact Kaiser Permanente directly for information about retail, mail-order prescriptions and order refills at:
Toll-Free 1-800-464-4000; Spanish 1-800-788-0606
For a complete description of prescription drug benefits, Continue Reading
Direct Pay Plan for Retired Participants & Dependents Not Eligible for Medicare
Under the Direct Payment Plan for Retired Participants and Dependents who are not Eligible for Medicare, some Covered Expenses require a prior approval before they are obtained, and some Covered Expenses require that you use certain health care providers in order to receive full Plan benefits. You will pay more of your Covered Expenses if you do not obtain a prior approval or if you use more costly health care providers.
For a complete description, Continue Reading
Direct Pay Plan for Retired Participants & Dependents Eligible for Medicare
Enroll for Medicare
On the first day of the month in which you or your Dependent spouse turn age 65, you are Eligible for Medicare.
Generally, Hospital (Part A) is automatic, premium free and requires no enrollment (for most workers).
Medical (Part B) requires enrollment 3 months before your 65th birth date. You or your Dependent spouse may also be Eligible for Medicare prior to age 65 if you have qualified for a Social Security Disability. In this case, you must notify the Trust Fund Office immediately upon receipt of your Medicare ID Card.
For a complete description, Continue Reading.
