MICHIGAN LABORERS’ HEALTH CARE FUND

COMMON QUESTIONS ASKED

 

 

How are my benefits Funded?

 

The primary source of financing for the benefits provided under the Health Care Fund and for the expenses of Fund operations is employer contributions.

 

What are the Fund’s eligibility requirements?

 

Initial eligibility requires 700 hours of contributions within six (6) months or less.  There is a one (1) month bookkeeping period in which you are not eligible.

 

Continuing eligibility requires 350 hours of employer contributions within three (3) months or less.  There is a one (1) month bookkeeping period in which you are not eligible.

 

What do I do if my employer does not remit my fringes?

 

First call your employer.  There may be a very good reason that the fringes have not been remitted.  If your employer cannot explain the reason to your satisfaction, you should contact the Local Union.

 

How can I add my dependents to the Plan?

 

Complete a “Membership and Record Change Form” and submit copies of marriage or birth certificates.

 

What do I do when I get divorced?

 

You must send a copy of your complete divorce decree otherwise coverage will be maintained for your ex-spouse.  If the Fund pays for benefits that should not be paid because your spouse no longer meet the definition of a dependent, you will be held responsible.

 

When does coverage stop for my dependent children?

 

Dependent children are covered through the end of the year in which they turn 19 unless they meet the requirements for maintaining coverage.  The Plan requires the following to maintain coverage beyond the age of 19; the child is dependent on the participant for more than half of their support, related to the participant by blood, marriage or legal adoption and is a full time student for at least five months of the year.

 

 

 

Can I continue coverage when I retire?

 

Yes provided you meet the retiree requirements for maintaining coverage.

 

What do I do if I am injured and cannot work?

 

The Fund provides disability credit which may continue your coverage for health care benefits.  You should complete a disability form.

 

What are the self-payment rates?

 

Active participant and family---------------------------------        $331.00

Active participant and family with dental coverage-----------         $355.00

 

What is COBRA?

 

COBRA is the Consolidate Omnibus Budget Reconciliation Act of 1986.  COBRA requires that the Fund provide coverage for participants and their dependents that may not otherwise be offered.  COBRA is available for dependents who no longer meet the definition of a dependent as defined by the Plan.  The rates are 102% of the actual cost of providing benefits. 

What is Coordination of Benefits?

 

Coordination of Benefits or COB coordinates benefits with other health benefits you may have such as coverage through your spouses employer.

 

How frequently are dental cleanings covered?

 

Dental cleanings or Prophylaxis are covered once every six (6) months.

 

What is the dental benefit maximum?

 

The dental benefit maximum is $1,000 per person, per calendar year.

 

What is the orthodontic benefit maximum?

 

The lifetime orthodontic benefit maximum is $2,250 per participant.