Insurance Frequently Asked Questions

Please refer to the OLDC-OCA Insurance Fund’s Summary Plan Description (SPD) for a more detailed explanation of all your insurance benefits.

Eligibility

Generally, once you have worked at least 450 hours in a six consecutive month period, you are eligible for insurance benefits on the first day of the following month. For example, if you worked 450 hours or more in the months of April, May, and June; you would generally become eligible for insurance benefits starting in July. Additionally, your contractor must report and pay the fringes due before you will become eligible. Remember there is a one month lag in contractors reporting working hours. (Example: June hours are not due to be reported until July.) This lag in reporting will result in a delay of you being notified that you have become eligible.

Once you meet the initial eligibility requirements for insurance benefits, your continued eligibility is determined using three different calculations. Each and every month is looked at individually when determining future eligibility. If you meet the minimum hours criteria of any of the three calculations for a given month, you will be eligible for that month. In general, the more hours you work, the longer you will be eligible. Your eligibility will continue if you work at least:

  • 250 hours in the first 3 months of the 4 months immediately preceding the month of coverage; or
  • 500 hours in the first 6 months of the 7 months immediately preceding the month of coverage; or
  • 1,000 hours in the first 12 months of the 13 months immediately preceding the month of coverage.

If your eligibility ends, you will be offered continued coverage through self-payments/COBRA. Additionally, your contractor must report and pay the fringes due before your eligibility will be extended. 

It depends on how long you have been without insurance coverage with the Fund. If you have not been eligible for insurance benefits for a year or longer, you must meet the initial eligibility requirements of 450 hours in a six consecutive month period. If the period without insurance eligibility was less than one year, you will re-establish your eligibility when you work at least:

  • 250 hours in the first 3 months of the 4 months immediately preceding the month of coverage; or
  • 500 hours in the first 6 months of the 7 months immediately preceding the month of coverage; or
  • 1,000 hours in the first 12 months of the 13 months immediately preceding the month of coverage.

The payment due is based off of your previous working hours. Basically, you are being billed for the least amount of hours needed to maintain eligibility. Currently, self-contribution payments will not exceed $1,750.00 for a three month period. The $1,750.00 is not broken down evenly over the three months; the amount due varies from month to month. Rates are based on the current (as of 5/1/19) contractors’ contribution rate which is $7.00 per hour. When contractors’ contribution rates change, the self-contribution rate will change accordingly.

Yes, if you are a member and eligible for insurance benefits on your date of death, your named beneficiary is entitled to a death benefit. The benefit amount is $14,000 for Class 1 members (actives) and $2,500 for Class 2, 3, and 4 members (retirees). If you are not eligible for insurance benefits on the date of your death, there is no death benefit available.

You can check your hours through MemberXG. If you don’t have access, you can call the Ohio Laborers Benefits office for assistance.

You must be at least 53 and eligible for insurance when you retire from the LDC&C Pension Fund in order to be offered retiree insurance. In general, the health insurance will be the same as you had while you were working until you become eligible for Medicare and it becomes your primary insurance (please see the following question for additional details on transitioning to Medicare primary). There are two exceptions: the death benefit decreases to $2,500 and you are no longer eligible for Short Term Disability benefits once you start retiree insurance.

The cost of retiree insurance depends on the number of pension credits you have and whether or not you cover your spouse and or dependent children. The more pension credits you have with the LDC&C Pension Fund, the cheaper your retiree insurance will be. (Note: The below examples are based on current rates and are subject to change.)

  • For member only coverage not eligible for Medicare, your monthly cost will start at $578, but will be reduced 2% per pension credit. 
  • For family coverage (all not eligible for Medicare), your monthly cost will start at $1,203, but will be reduced 2% per pension credit.
  • Additional rates may be applicable if you and or your spouse/dependent(s) are eligible for Medicare or have other insurance coverage.

When you or your covered dependent become eligible for Medicare (typically at age 65), your monthly rate will be adjusted when applicable. You and/or your dependent will be transitioned to the Humana Group Medicare Advantage Plan for both medical and prescription benefits. Ohio Laborers Benefits will auto enroll you and/or your dependent with Humana. You and/or your dependent must enroll in both Part A and Part B of Medicare and send a copy of your (or your dependent’s) Medicare Card to Ohio Laborer Benefits. Any non-Medicare eligible dependents will remain covered by Anthem and Envision.

  • If you enroll in a Medicare Advantage Plan (Part C) or Medicare Prescription Drug Plan (Part D) other than the Fund’s Humana Plan, you and your dependents will not be eligible to participate in the OLDC-OCA Insurance Fund.
  • If your dependent enrolls in a Part C or Part D plan other than the Fund’s Humana Plan, the dependent will not be eligible to participate in the OLDC-OCA Insurance Fund; however, you and any other covered dependents can remain eligible with the Insurance Fund.
  • If you choose another insurance option, please notify Ohio Laborers Benefits.

Yes. The Fund has a limited benefit. Please review the Plan’s Summary Plan Description or contact Anthem for additional details.

Eligible members can receive up to $280 per week for up to 20 weeks if sick or injured and unable to work. In addition to the monetary benefit, members may receive up to 300 disability credit hours toward their insurance which could extend eligibility. Also, members may be eligible for up to 2 pension credits or 2,000 pension hours per lifetime from the disability. No monetary benefit is available for work related disabilities. 

Members must be covered under the OLDC-OCA Insurance at the time of the incident to be able to receive this benefit.  The Short Term Disability benefit will terminate when the Member’s insurance eligibility ends. Please review pages 87-89 of the Insurance SPD for more information on Short Term Disability benefits. 

Typically, your insurance and pension contributions must be submitted to the fund’s jurisdiction in which they are worked. So if you didn’t work in Ohio, chances are your hours were reported to another fund. If the hours are not reported to the OLDC-OCA Insurance Fund, we cannot credit the hours toward your insurance eligibility. You may be able to have the hours transferred to this Fund by completing a Reciprocal Transfer Request form and submitting it to Ohio Laborers Benefits. If you worked in another jurisdiction, please contact Ohio Laborers Benefits for the request form. Certain funds may not have an agreement with this Fund to transfer hours. Additionally, you must complete the transfer request timely; most funds will only transfer back for a limited time.

Dependents

To add a child to your insurance coverage, you must submit an Enrollment/Beneficiary Card and a copy of the child’s state issued birth certificate to the Benefits Office.  You can complete and submit the Enrollment Card through your MemberXG account. You can also contact the Benefits Office to have an Enrollment Card sent to you. 

  • For newborns, if you do not yet have the birth certificate, you can submit the child’s hospital birth record with the Enrollment/Beneficiary Card. The hospital birth record will be sufficient to enroll the child until the age of one. You must provide the Benefits Office with the child’s social security number and state issued birth certificate to extend the child’s eligibility past the age of one.
  • To enroll a stepchild, you must also submit a copy of your marriage certificate to the biological parent of the child.
  • To enroll an adopted child, you must also submit proof of adoption or the intent to adopt.
  • To enroll a child named recipient under a QMSCO or NMSN, you must also submit a copy of the QMSCO or NMSN.
  • To enroll a child through legal guardianship/custody, you must also submit a copy of court documents granting guardianship/custody.
  • To enroll a disable child age 26 or older, you must submit proof of disability.
  • To enroll a spouse, you must submit your marriage certificate. 
You can upload necessary documents through MemberXG

Your ex-spouse (and or step children) are still covered because you have not submitted a complete copy of your final divorce decree. In addition to a divorce decree, you should also submit a new enrollment card to update your beneficiaries.

Make sure you update Ohio Laborers Benefits if your address changes. Updating your address at your Local does not change it at the Benefits Office. To update your address you can send a note or Address Change Card to the Benefits Office that includes your new address, Social Security number, and your signature. You can also call the Benefits Office and update it over the phone (members only). If the Benefits Office receives return mail due to an incorrect address, your insurance and pension benefits may be suspended.

Members can update their address online through MemberXG 

In general, your dependents will be eligible for medical, vision, and prescription drug benefits while you are eligible for Class 1 Insurance. Children and stepchildren can only be covered until they turn age 26. Eligibility for permanently disabled children may be extended. Spouses can be covered while married to the member.

Your dependents will become eligible on the later of two dates:

  1. The date on which you become eligible, or
  2. The date of your dependent’s qualifying event (marriage, birth, adoption, etc.)

Even though your dependent’s eligibility may be retroactive based on the above rules, enrollment and claims submissions should be done as soon as possible to avoid claims being denied due to untimely filing.

No, the member must be eligible for insurance benefits in order for dependents to be eligible. If you are an active member, you cannot simply cancel your insurance, but whether or not you use it is up to you. Your eligibility is based on hours reported by contractors. If you are a retired member, cancelling your insurance also cancels the eligibility for any dependents; and you will never be able to recover your insurance once you cancel.

No. Only spouses and children (biological, step, adopted, etc.) are considered eligible for coverage under the Plan.

If you are retired, your widow will be entitled to maintain coverage if eligible under the Plan at the time of your death. If you are not retired, your widow will only be eligible for 36 months of COBRA coverage, assuming he/she was eligible at the time of your death.

Billing/Claims

You are no longer eligible for insurance benefits due to insufficient working hours being reported on your behalf. You can continue your eligibility by paying the bill.

Your claim could have been denied for many reasons. Since Ohio Laborers Benefits does not process your medical, prescription, or vision benefits in house, you should contact the appropriate claims administrator to answer this question. 

  • Medical claims – Anthem Blue Cross Blue Shield: 855-878-0128
  • Medicare primary medical and prescription claims – Humana:  800-733-9064
  • Prescription claims – EnvisionRX: 833-652-2799
  • Vision claims – National Vision Administrators: 800-672 – 7723
  • Hearing claims – HearUSA: 800-442-8231

A Coordination of Benefits form is used to determine if you and your dependents have another insurance plan in addition to the OLDC-OCA Insurance plan.  Our insurance carrier, Anthem, will then determine which claims should be paid as primary and secondary for Members. Simply – to make sure claims are paid correctly.

Simply call Ohio Laborers Benefits and request one.

Yes. Precertification is done through Anthem Blue Cross Blue Shield. Precertification is also required for certain other services. For emergency admissions, you, your authorized representative, or physician must notify Anthem within 2 business days after the admission or as soon as possible within a reasonable amount of time.