The PPACA and You

In 2010, the Patient Protection and Affordable Care Act (PPACA), also known as "Health Care Reform," was signed into law. The law sets new rules and regulations for the health care industry while broadening access to health care, and helps make health care more affordable for participants.

Two ways the PPACA affects participants is by increasing the coverage age for dependent children to age 26 and covering in-network preventive care at 100%.

Coverage of Children to Age 26

Children of covered Benefit Trust Fund employees, including legal step-children and adopted children, can be listed as eligible dependents until the child reaches age 26. Read the Fund's notice of extending coverage to children up to age 26 (PDF).

You no longer need to submit full-time student verification for children beginning at age 19 in order for them to be listed as eligible dependents. To enroll an eligible child, complete an Enrollment Form (PDF) and fill out an Eligible Dependent Certification Form (PDF) where required.

Preventive Care

In-network preventive care under Benefit Trust Fund medical plans is covered at 100%. You do not have to meet the annual deductible or pay coinsurance when receiving preventive care from an in-network medical provider.

Preventive care includes yearly checkups and certain routine screenings. Well-child visits and routine immunizations are also considered covered preventive services. View a complete list of preventive services covered under the PPACA.

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With the ACA, in-network preventive care under Benefit Trust Fund medical plans is covered at 100%.

Frequently Asked Question (FAQ)

How many different plans does the Fund offer?

The Fund offers multiple Medical, Dental, and Vision plans. Short-Term Disability and Life and Accidental Death & Dismemberment benefits are also available.

How do I notify the Fund of my address change?

If you move, please notify the Fund of your new address. To change your address,
fill out a new Enrollment Form and mail or fax it to the Fund using the mailing address or fax number found on the form. Always complete a new Enrollment Form when you have a change in personal information.

Do Medical Plans include Prescription Drug Coverage?

Yes. Our Plans include excellent prescription drug benefits.

What is a PPO?

A Preferred Provider Organization is a type of medical plan that covers the cost of eligible medical care and services received from network and non-network providers. Network providers (primary care doctors, specialists, hospitals, and other medical facilities) agree to a discounted fee schedule for services provided. When a participant or covered family member sees a network provider for care, the participant pays less out of pocket because of the discounted fees. The Fund contracts with CIGNA Healthcare for the use of their nationwide network of participating providers. There are currently more than 750,000 participating providers in the CIGNA "Open Access Plus" Network—the network used by the Fund’s medical plans.

Are participants required to receive services only from a PPO provider?

No. Participants have the choice of selecting a non-PPO physician. However, receiving services from a physician who participates in the CIGNA network may result in significant savings for participants.

Must participants have a referral from their primary care physician in order to see a specialist?

No. Referrals are not required.

Who processes health care plan claims?

Medical claims are processed by CIGNA Healthcare. Dental claims are processed by Delta Dental Insurance Company, and Vision claims are processed by Fund Office staff.

Do the Fund plans have a waiting period for "pre-existing conditions" under the medical plans?

No. The waiting periods for pre-existing conditions were waived for all plans by the Board of Trustees.

What are the age limits for dependent children?

Children can be covered dependents until they reach age 26 providing they continue to meet provisions for dependent coverage.

Does the Fund offer COBRA coverage for health care?

Yes. The Fund administers COBRA for its Contributing Employers. Upon notification from the Employer that a participant is losing coverage due to a "qualifying event," the Fund will send notification to the participant advising him or her of COBRA rights to continue health care coverage by making payments to the Fund Office.

Does the Fund offer Retiree Health Care Plans?

Yes. Employers that have negotiated a Benefit Trust Plan for their Active employees may also establish a Retiree plan.

How Do I Find a Contributing Employer?

To find a Contributing Employer click on this link to view a map and listings by territory.

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