Can members over the age of 65 enroll in the Medical plans?

• Yes, but these Union medical plans must be primary and not enrolled in Medicare.

What are the requirements for these plans?

• Must have ownership in a valid business entity with a Federal Employer Identification Number (FEIN) and be actively working.

When do these plans renew?

• Union Medical plans operate on a calendar year deductible and OOPM framework; this means Deductibles and Out of Pocket max will reset every January 1. If covered by a plan, you are not asked to actively re-enroll, though you may change plans at this time. Your enrollment remains in place until you terminate or are terminated from the plan.

When can I enroll?

• You may enroll at any time of the year; however, you must enroll by the 15th of the month prior to your desired effective date. (Ex: 6/1/24 enrollments must be completed by 5/15/24).
• The Union does not allow retroactive enrollments or terminations. Transactions must be completed by the 15th to become active by the first day of the next month.

Who is the carrier for the Union medical plans? What kind of network of coverage? How do I know if my doctor is part of the network?

• The plan sponsor is the Amalgamated Local 426 Health and Welfare fund, and the plan utilizes the nationwide Anthem BlueCard PPO network. The plan is governed by Federal ERISA law and not subject to state insurance law.
• You can check if your doctor is part of the network – click on the 'Find a Provider' link at the bottom of each of the plan cards.

Are there exclusions?

• This Plan will not pay for any expenses incurred as the result of a motor vehicle accident. When an injury is caused by a motor vehicle accident, your no-fault automobile insurance must cover and pay for the medical cost and charges for that injury. It has become popular for States to attempt to transfer the automobile carrier's liability over to the employee's medical plan. It is the obligation of the automobile owner to purchase sufficient medical coverage in their automobile insurance plan.
• This plan does not pay for any condition, illness or injury, or complication thereof, arising out of engaging in a hazardous hobby or recreational activity, defined as an activity for which a waiver or disclaimer is required to participate in such activity. Examples of such activities include skydiving, auto or airplane racing, hang gliding, bungee jumping, mountain or rock climbing, or parachuting, water-skiing, deep-sea diving, jet ski operating or snowmobiling, motorcycling and all-terrain vehicle riding.
• Specialty Medications are EXCLUDED from these plans. The Union has identified a specialty pharmacy vendor, Payer Matrix, to assist members with obtaining their needed specialty medications and will provide members with that contact information upon confirmation of enrollment in the plan. This is a plan cost containment feature as the national cost of Specialty Medications have become the leading driver of increased health plan costs. For information on whether your prescription is covered, click on the link "View Rx Formulary" under each plan card.
• Maternity (labor and delivery) coverage is limited to primary employee and spouse only.

Who is covered?

• You may cover a spouse and children with whom you have a legally documented relationship. Prior to the plan coverage date, you will be asked to provide legal verification of these relationships such as marriage and birth certificates. Unmarried domestic partners and foster children are not eligible.
• If a covered individual has a Qualifying Life Event (QLE) and must add or remove a dependent, this must be updated within 30 days of the event. QLE examples include marriage, divorce, dependent birth or death and losing or gaining coverage elsewhere.
• You may also change plans at this time.

What if I terminate and then change my mind?

• If coverage terminates, regardless of reason, you must satisfy a six-month waiting period to re-enroll in any of the plans.

How do I pay and when? What happens if payment fails?

• Payment is via ACH – you will be asked for your banking information at the end of your enrollment. Payments are pulled around the 18th of each month prior to the effective date.
• If payment fails, members will be required to perform a domestic wire transfer to the Union's bank account prior to the 28th of the month for the following month's coverage while incurring any domestic wiring fees that could result from the wire transfer (currently $30).
• If premiums are not cleared by the 28th of the month, coverage is terminated, and benefits cannot be reinstated until January 1st. If there is intent to reinstate after termination, Decisely must be notified before December 1st.

Who can enroll in this Medical plan? Group/Individuals?

• These medical plans can be written down to the sole proprietor level but also offered in a traditional group/employer sponsored setup.

When offering these Union Medical plans on a true Group setting who is eligible to enroll?

• Both W-2 employees and 1099 contractors can enroll in the medical plans that are offered at a group level. An employer may wish to support employee premiums with a financial contribution as this can be good for employee retention, but unlike other group plans, these require no employer contribution.
• When the group is onboarded, only the sponsoring employer's FEIN is needed.

Are there any Employer Contribution Rules for premiums or any minimum employee participation rules?

• NO