Answers
If I am covered under the UEBT Retiree Health Plan (the “UEBT Retiree Plan”) as a Surviving Spouse and I become covered under other group health coverage from my employer, can I re-enroll in the UEBT Retiree Plan once I retire from my job and lose that coverage?
No. If a Surviving Spouse/Domestic Partner becomes covered under another Active or Retiree group health plan while also covered under the UEBT Retiree Plan, coverage under the UEBT Retiree Plan will be terminated and the Surviving Spouse will not be able to re-enroll in UEBT Retiree Plan in the future.
If I am a covered as a Surviving Spouse and I am already covered by another group health plan, can I opt out of the UEBT Retiree Plan and re-enroll in the future?
Yes. A Surviving Spouse/Domestic Partner who opts out of the UEBT Retiree Plan while already covered by other group health coverage may re-enroll in the UEBT Retiree Plan when the other group coverage terminates. The request for re-enrollment in the UEBT Retiree Plan must be received within 60 days of losing the other coverage or during the next Open Enrollment period for the UEBT Retiree Plan. If these timelines are not met the Surviving Spouse/Domestic Partner will not be able to re-enroll in the UEBT Retiree Plan in the future.
If my employed Spouse/Domestic Partner or working Dependent child do not have other group coverage available to them, what documentation do I need to submit?
The Trust Fund Office requires documentation on the employer’s letterhead confirming health insurance is not available to your Spouse/Domestic Partner or working Dependent child.
What if I don’t know if my Spouse/Domestic Partner or working Dependent child are eligible for other group health coverage?
You should contact your working Dependent child or Spouse’s/Domestic Partner’s employer(s) and/or former employer(s) to ask about available coverage.
Does the rule for enrolling in another employer group health plan apply to me, the Retiree, if I return to work for another employer?
Yes, you are required to enroll in the group health plan offered by your current employer.
If I or my Spouse/Domestic Partner opt out of the UEBT Retiree Plan due to having other coverage, are we allowed to re-enroll in the UEBT Retiree Plan during the following Open Enrollment period and keep our other insurance coverage?
No. If you opt out of the UEBT Retiree Plan, you can only request re-enrollment if you lose your other group coverage.
My Spouse/Domestic Partner currently has other coverage and chose to opt out of the UEBT Retiree Plan. How do I notify the Fund Office if she or he loses that other coverage and wants to re-enroll in the UEBT Retiree Plan?
You must contact the Fund Office within 60 days of your Spouse/Domestic Partner losing that other coverage, or at the first Open Enrollment following the loss of coverage, in order to re-enroll your Spouse/Domestic Partner in the UEBT Retiree Plan. If you do not meet these timelines, your Spouse/Domestic Partner will never be allowed to re-enroll in the UEBT Retiree Plan.
If a Retiree does not want to cover a Spouse/Domestic Partner, but does want to cover Dependent children, can they?
Yes, if a Dependent child is eligible for coverage under the UEBT Retiree Plan, the Retiree can enroll the Dependent child without enrolling their Spouse/Domestic Partner. The Retiree is not required to enroll their Spouse/Domestic Partner. For retirements on and after March 1, 2013, the Retiree must have at least 25 Benefit Accrual Credits (BACs) under the Pension Plan to cover Dependent children under the UEBT Retiree Plan.
If I am a Retiree and I have access to other group health coverage, am I required to enroll my Dependents in that other coverage?
No, you must enroll yourself in the coverage, but you are not required to cover your Dependent Spouse/Domestic Partner or children.
What if I have other individual coverage (i.e., not through a group plan offered by an employer); can I drop my coverage through the UEBT Retiree Plan and re-enroll later?
No. If you drop UEBT Retiree Plan coverage for any reason other than being covered by other group health coverage, you will not be able to re-enroll in the UEBT Retiree Plan. Individual coverage does not preserve your right to re-enroll in the UEBT Retiree Plan. However, enrollment in coverage through the Covered California Healthcare Market Place will preserve your right to re-enrollment at a later date in the UEBT Retiree Plan.
My child is covered as a full time student under the UEBT Retiree Plan. How often must I submit the Student Certification form to confirm the full-time student status for my child?
Student Certification documentation is required each school period. The Student Certification form must be received within 60 days of the beginning of the semester or quarter. If the Student Certification form is not received timely, your child will not have coverage and you will have to wait until the next Open Enrollment period to enroll your child.
Who determines what constitutes full-time student status?
Full-time student status is based on the definition established by the accredited institution that your child is attending.
Will a full-time student letter of intent be required to cover the summer months for a Dependent child who attends school during the Spring semester (the semester/quarter ending in May or June) and intends to go back to school in the Fall semester or quarter (generally starting August – December)?
Yes. However, in the event the student does not return to school as indicated in the intent letter, coverage will be terminated back to the end date of the last student certification and the Retiree must repay any claims paid by the UEBT Retiree Plan during the period of ineligibility.
Is COBRA offered to a Dependent child who loses coverage because they are no longer a full-time student or no longer qualify for coverage as a Dependent because they have aged out?
How will the Student Certification be addressed in the Open Enrollment?
When you enroll a Dependent child age 19 through 23 during Open Enrollment, you will be given information about the Student Certification requirements and documentation you must provide by the deadline before enrollment can be completed.
Are there any Kaiser Dependent premiums?
The premiums for Kaiser Coverage under the UEBT Retiree Plan are the same as the UEBT Retiree PPO plan and are based on years of credited service and Medicare eligibility status. Note that non-Medicare Retirees will pay the same premium without regard to whether they have individual-only coverage or if they cover one or more Dependents, whereas a Medicare Retiree will pay a per-enrolled-person premium.
This does not apply to Self-Pay Retirees. For the UEBT Retiree plan details please reference your Open Enrollment information or contact the Trust Fund Office.
Can I enroll my grandchild if I have been appointed as a legal guardian?
No, legal guardianship alone is not enough to establish eligibility for your grandchild. The UEBT Retiree Plan will provide coverage for a natural child, step-child, adopted child, a child who has been placed with you for adoption, or a foster child.
I am covered by another group health plan, which is primary over the UEBT Retiree Plan. If my primary plan paid more than the UEBT Retiree Plan allowed, am I still responsible for the patient’s portion from the primary plan even though the UEBT Retiree Plan did not pay anything?
Typically, yes. If a primary plan pays more than the UEBT Retiree Plan would have paid if it were the primary plan, the patient is responsible for the patient’s portion due under the primary plan. Contact your primary plan for more information.
If the UEBT Retiree Plan is secondary and my primary plan denies my claim as being the patient’s responsibility, does the UEBT Retiree Plan pay as primary or do I have to appeal to my primary Plan for reconsideration?
This depends on your primary plan’s reason for the denial. For instance, if your primary plan denied the claim for untimely filing, there may not be any benefit paid under the UEBT Retiree Plan if it was also untimely filed under the UEBT Retiree Plan. If the primary plan denied the claim because the service is a plan exclusion, but the service is covered under the UEBT Retiree Plan, the UEBT Retiree Plan would process the claim as primary. If the primary plan denied the claim because the service was not authorized, you should appeal to the primary plan.
When the UEBT Retiree Plan is secondary, which of my out-of-pocket expenses are applied to my UEBT Retiree Plan yearly out-of-pocket maximum?
Amounts you are required to pay for Deductibles and Coinsurance by your primary plan do not count towards the deductible and out-of-pocket maximum limits under the UEBT Retiree Plan. Only amounts required to be paid by you under the UEBT Retiree Plan apply to your UEBT Retiree Plan out-of-pocket maximum.
Does a PPO provider have to accept Blue Shield’s allowed amount for services as payment in full?
Yes. Blue Shield of California PPO providers have agreed to accept Blue Shield’s contracted rate as payment in full for covered services. However, if you are covered by Medicare and the Blue Shield allowable charge is less than the Medicare allowable charge, the provider may bill you for the balance, up to the Medicare allowable charge.
Is pregnancy covered for the Retiree or the Retiree’s Spouse or Dependent children?
No. Pregnancy benefits are not covered under the UEBT Retiree Plan.
If I am enrolled in Kaiser, does the Deductible apply to Kaiser Non-Medicare office visits?
No, office visits require a $20 copay per visit. The Deductible does not apply to the office visit. However, if other services are provided as part of the office visit, such as lab or x-rays, the Deductible or Coinsurance applies to those services.
Is there going to be a change to the Retiree or Dependents yearly dental benefit maximums or the yearly out-of-pocket maximums?
No, not at this time. However, the Board of Trustees reserves the right to increase or terminate benefits at a future date.
Can a non-Medicare Retiree enroll in Health Net?
No. Health Net is only available to a Medicare Retirees whose Spouse/Domestic Partner and eligible Dependent children are also Medicare-eligible.
How can I get information about the prescription drug benefit and how will I know if I am taking a non-preferred medication under the new MPD program?
If you have filled a prescription for a non-preferred medication you will receive a letter from EnvisionRx identifying the non-preferred medication, the preferred alternative medication, and the cost to you if you choose to continue to receive the non-preferred medication.
If you are enrolled in Kaiser the MPD program does not apply to you.
Can my doctor request an exception request for non-preferred medications?
Yes. To be considered for an exception, your doctor must complete and submit the exception request form to EnvisionRx, which is available on the Trust Fund website under the “Resources” and “Forms” tab.
If EnvisionRx denies an exception request to the preferred alternative medication I am required to take, what can I do?
You may appeal the denial to the Board of Trustees. All appeals received will be reviewed and decided in accordance with the applicable laws and the follow the Plan’s normal claims and appeals procedures.
Is the prescription annual deductible still $100.00?
Yes, it is still $100 per person.
If you are enrolled in Kaiser Senior Advantage you receive your Prescription Benefits through Kaiser and there is no deductible.
What is Dual Coverage?
Dual coverage refers to two married individuals or Domestic Partners who meet all the Plan’s eligibility requirements, and as a result, are provided 100% network coverage and will not be subject to Coinsurance, Copayments, or Deductibles. This 100% benefit does not apply to non-network services or non-preferred prescription drug Copayments.
Dual Coverage applies when both Participants are covered as employees by the UEBT Active Plan, when both are covered as Retirees under the UEBT Retiree Plan, or when one is covered by the UEBT Retiree Plan and one is covered by the UEBT Active Plan, if the following requirements are met: both must be (1) enrolled with the same carrier, (2) have authorized premiums at the same level, and (3) if an Active member(s), must elect (and participate in) the Health Care Partnership (HCP) Plan option.
Does dual coverage apply when one employee is Active and the other is a Retiree?
If two members, Active or Retired, both enroll in Kaiser, will the Plan continue to reimburse Copays?
Yes, but only if the Active Member and Spouse are enrolled in the Kaiser HCP plan.
Will the Plan reimburse the Deductible or Coinsurance required of the Kaiser Plan?
Yes, but only if the Active Member and Spouse are enrolled in the Kaiser HCP plan.
If one Member elects Kaiser and the other elects Blue Shield PPO, do the dual coverage rules apply?
No. There is no dual coverage under this scenario and standard non-duplication of benefit rules apply. There is no reimbursement of Kaiser Copayments.
Can a Surviving Spouse who had dual coverage maintain it after the Spouse dies by paying double premiums?
When one Spouse/Domestic Partner retires while the other is Active, can they elect to be covered as a Dependent under the UEBT Active Plan and preserve their right to enroll in the UEBT R when that active coverage ends?
How is dual coverage applied for an Active member who is also a covered as the Dependent child of another Active member)?
Members who are eligible under the Standard Plan on their own but also eligible as a Dependent child will receive the higher level benefits available (generally as a Dependent).
If I opt out of the UEBT Retiree Plan because I am eligible for Tri-Care, will I be allowed to re-enroll in the UEBT Retiree Plan if I lose Tri-Care coverage?
Yes, if you apply for re-enrollment within 60 days of losing Tri-Care coverage, or at the next Open Enrollment.
If a UEBT Retiree opts out of UEBT Retiree Plan coverage due to the member having other employer sponsored coverage but dies during this period, is his or her Surviving Spouse eligible to re-enroll in the UEBT Retiree Plan (so long as proof of creditable coverage is provided)?
Yes. The Surviving Spouse may opt back in if proof of the loss of coverage is provided to the UEBT Retiree Plan within 60 days of loss of coverage, or at the next Open Enrollment.
If I am a UEBT Retiree and want to elect dual coverage with my eligible Spouse/Domestic Partner for medical benefits, do we also have to elect dual coverage (i.e. both elect the same dental carrier and cover each other as Dependents) for our dental elections?
No. You do not have to elect dual dental coverage in order to have dual medical coverage. If dual dental coverage is desired, however, and you have elected dual coverage for your medical plan, then you must also elect dual coverage for your dental plan.
Can my non-enrolled Spouse/Domestic Partner who has other group health coverage enroll in the UEBT Retiree Plan if they lose the other coverage?
Yes, a Retiree and/or Spouse/Domestic Partner can enroll in the UEBT Retiree Plan due to loss of other coverage but must provide proof (evidence of other group coverage) and request to re-enroll within 60 days of the loss of other coverage or at the next Open Enrollment. If proof of loss of coverage and a request to enroll is not provided within 60 days of losing coverage, or the next Open Enrollment after losing coverage, the Spouse/Domestic Partner will not be able to reenroll in the UEBT Retiree Plan.
Is Retiree vision care through VSP also available to HMO participants? Is it part of the Medical/Rx premium?
Yes.
This does not apply to Self-Pay Retirees. For UEBT Retiree plan details please reference your Open Enrollment information or contact the Trust Fund Office.
Is there a PPO out-of-pocket coinsurance maximum for the family?
Yes, the PPO out-of-pocket maximum is $3,000 per person / $9,000 per family.
If I am enrolled in the Indemnity Medicare plan can I buy an individual Medicare Supplement plan to help pay some claims expenses not covered by UEBT Retiree Plan (due to non-duplication of benefits)?
Yes. Due to non-duplication of benefits, the Indemnity Medicare plan provides limited medical reimbursement. You may wish to purchase your own INDIVIDUAL Medicare Supplemental plan to help offset these claims expenses. Please note that the main benefit provided to Medicare Indemnity participants is the Prescription Drug coverage. It is VERY important that if you buy your own individual Medicare Supplemental plan, it MUST NOT have prescription drug (Part D) coverage. Members who purchase individual Part D coverage will be dropped from the UEBT Retiree Plan prescription drug coverage.