Health and Welfare FAQs

The 1095-B is a new IRS tax form required under the Affordable Care Act (ACA). Starting with tax year 2015, if you or a family member were covered under a government-approved medical health Plan at any time during the year, then your health coverage provider must produce this form, indicating which months such coverage existed, and for whom. 

A copy will be sent to…

  1.  You (the H&W Participant) no later than March 31, 2016, and
  2.  The IRS, no later than June 30, 2016.

This form serves two main purposes. As applicable, it will help you, as a taxpayer…

  1.  Document what medical coverage you and your family members had (if any), and
  2.  Determine if you qualify for an ACA exemption, or if you owe additional tax. 

Be sure to retain this form with all your other supporting tax documents. You should not send it in with your tax return. If someone helps you prepare your tax return, you should make sure they are aware of this form. Ask your tax preparer or advisor if you have specific questions while filing your taxes. Everyone’s tax situation is different, and Carpenters Southwest Administrative Corporation is not able to give you tax advice. Also, be sure to read the form's "Instructions for Recipient," as well as any supplemental inserts. Visit the IRS web page on this topic to learn more. 

The 1095-C is a new IRS tax form required under the Affordable Care Act (ACA). Starting with tax year 2015, if you were employed an average of 30 hours per week in any month, by an employer who is required by the ACA to either provide or offer you government-approved medical health coverage, then that employer must produce this form. 

A copy will be sent to…

  1. You (the employee), no later than March 31, 2016; and,
  2. The IRS, no later than June 30, 2016.

This form serves two main purposes. As applicable, it will help you, as a taxpayer…

  1. Document what medical coverage your employer made available to you (if any); and,
  2. Determine if you qualify for an ACA exemption or tax credit; or, if you owe additional tax.

Be sure to retain this form with all your other supporting tax documents. You should not send it in with your tax return. If someone helps you prepare your tax return, you should make sure they are aware of this form. Also, be sure to read the form's "Instructions for Recipient," as well as any supplemental inserts. Ask your tax preparer or advisor if you have specific questions while filing your taxes. Everyone’s tax  situation is different, and Carpenters Southwest Administrative Corporation is not able to give you tax advice. Visit the IRS web page on this topic to learn more. 

Eligibility is granted by working 360 hours in a calendar quarter. For example, if you have at least 360 hours in January, February and March you will have coverage during May, June and July. Participants need a total of at least 360 hours (work hours and/or reserve hours) worked by contributing employers in order to qualify for coverage for the next eligibility quarter as shown in the chart below. The number of work hours required for initial eligibility by participants that have never been covered under the Active Plan will be 300 hours in a work quarter.  After initial eligibility has been established, the work hour requirement will revert to the normal 360 hours for any subsequent eligibility quarter.

Work Quarter Eligibility Quarter
If you have at least 360 hours by the close of the following 3 months: You have coverage during the next following 3 months of:
January, February, March May, June, July
April, May, June August, September, October
July, August, September November, December, January
October, November, December February, March, April

Your eligible dependents will become covered on the date your coverage is effective or on the date you acquire the dependent, whichever is later, providing all documents required for eligibility are received and approved by the Trust.

Any spouse or child that is eligible under the Trust as an employee (carpenter or special class employee) cannot also be eligible as a dependent. Nor can children be covered as dependents of more than one employee (carpenter or special class employee) under the Trust.

Plans vary by state and are based on a participant’s active status. First-time eligible participants are only eligible to enroll in an HMO Plan until the next Open Enrollment is offered. (The Fee-For-Service PPO Medical Plan Option is generally available only after you have completed a year of coverage under one of the HMO Options). The PPO Dental Plan is only for active participants that reside outside of a DMO service area. In addition to the Medical and Dental Options, the Trust provides a Vision Plan which you do not need to enroll in because you will automatically be enrolled once the Administrative Office receives your medical enrollment application.  Contact the Administrative Office for information on the Plans you are currently enrolled or see the Open Enrollment Benefit Comparison.

You can refer to your paycheck stubs or you can call the Administrative Office for a monthly breakdown of your hours.

The length of your coverage depends on the amount of Health and Welfare work hours reported to the Administrative Office on your behalf by your employer(s). The number of hours needed to qualify for eligibility under the Active Plan is 360 hours. The number of hours increased from 300 hours to 360 hours beginning January 1, 2015. If you work more than 360 hours during a work quarter, the excess hours will be credited to your reserve account. The current reserve account maximum is 720 hours. For first-time participants, the number of work hours required for initial eligibility by participants that have never been covered under the Active Plan will be 300 hours in a work quarter. After initial eligibility has been established, the work hour requirement will revert to the normal 360 hours for any subsequent eligibility quarter. 

Each year the Trust has an annual Open Enrollment period where participants can change their Plans. Plans vary by state and are based on a participant’s active status. More information about Plan benefits is available on this website under the Health & Welfare Tab

Identification Cards are mailed directly from the Health Plan you have selected. Please allow up to two weeks for your Identification Cards to be mailed to you. In most cases you can also go to the Health Plan’s website and print your own Identification Cards. If you need additional assistance, please call the Administrative Office.

Yes, but first contact the Administrative Office to confirm you are properly enrolled and verify your address. 

An address change must be submitted in writing to the Administrative Office. You can either print an Address Change Form here or send a letter to the Administrative Office with your new address information. The letter must include the participant’s full name, social security number or UBC number, new address, and have the participant’s signature and date. The address change will not be accepted without the participant’s signature. The Address Change Form and/or participant’s Address Change Letter may be sent by mail or fax to the following address: 533 South Fremont Avenue, Los Angeles, CA  90071-1706, Fax: (213) 739-9321.

You may submit copies of your employer paycheck stubs for the work quarter. Your paycheck stubs will be referred to the Trust’s Audit & Collection Department for review. The Administrative Office will notify you in writing of the outcome of your paycheck stub audit.

Please call the Administrative Office. You will need to submit the original Certified Death Certificate to the Administrative Office with the participant’s social security number or UBC number. The Administrative Office will verify that a Designation of Beneficiary Form is on file and help guide you through the process of how to submit a Death Claim for Life Insurance. 

The Administrative Office documents and processes Reciprocity Forms as they are received and notes if hours have been transferred from another Trust Fund. Call the Administrative Office to verify the receipt of your form.

If you take a job outside of the Southwest Carpenters jurisdiction and you want to have your hours transferred from an outside Trust Fund, then you will need to complete and sign a Reciprocity Form. On your behalf, the Trust will request your Health and Welfare and/or your Pension hours worked under another Trust. Reciprocity Forms must be submitted to the Administrative Office within 60 days from the date worked to avoid an interruption of health coverage. If you need additional information regarding your reciprocal request, please call the Administrative Office.  

When you are a newly eligible participant or have lost coverage for two eligibility quarters, the Trust requires you to enroll in an HMO/EPO Health Plan. You may change your Plan only during the Trust’s annual Open Enrollment period or if you reside outside of the HMO service area. (The Fee-For-Service PPO Medical Plan Option is generally available only after you have completed a year of coverage under one of the HMO Options).

If you did not select a Medical or Dental Plan during Open Enrollment and you are eligible for coverage, contact the Administrative Office for more information.

If an eligible individual who is an employee enters full-time active duty in the Uniformed Services of the United States, such individual and his dependents shall cease to be eligible individuals unless such eligible individual submits a written election to continue health coverage to the Administrative Office within 60 days of entering the Uniformed Services full time. If properly elected, coverage will be continued on a self-pay premium basis for up to 18 months.

First, you must contact your HMO Plan to inquire about the status of your bill. If the issue is not resolved, you can contact the Administrative Office and they can contact the HMO Plan on your behalf to try to resolve the issue. 

To appeal a denial of a benefit, submit a written appeal letter to the Administrative Office as soon as you receive the denial. Failure to submit the appeal in a timely manner may result in a denial, which cannot be overturned. More information on the Health and Welfare Appeal Process is available on this website. 

For the Fee-for-Service PPO Medical Plan, benefits are limited to coverage in the United States unless you are temporarily traveling or on vacation outside of the country and need to see a doctor. Treatment must be deemed a medical emergency in order to be covered. You must pay for the charges and submit an itemized bill, which includes the dollar amount, diagnosis, a breakdown per procedure, and the health provider’s name, address and telephone number. For the HMO Medical Plans, please contact your Health Plan directly for Plan coverage on emergency services outside of the United States.

The Trust only offers one Vision Plan to participants. It is the United Healthcare Vision Plan. If you have questions about network vision providers or the benefits available, contact United HealthCare toll free at (800) 638-3120 or visit their website at www.myuhcvision.com.

If you are enrolled in an HMO or EPO Medical Plan, your prescription drugs are covered by the HMO or EPO Health Plan. Refer to the benefit booklet issued by your HMO or EPO on how to obtain prescription drugs. If you are enrolled under the Fee-for-Service PPO Medical Plan your prescription is covered under the Express Scripts Plan. Under the Express Scripts Plan, you may take your prescription to a participating pharmacy or you may use the Express Scripts Mail Order Pharmacy. To contact Express Scripts, call (800) 987-7836 or visit www.express-scripts.com.   

No, if you reside within our DMO Service area, you must enroll in a DMO Dental Plan. If your primary residence is outside a DMO service area the Delta Dental PPO Plan is available.

No, changes to your Plan can only be made within the Open Enrollment period, unless you move outside an HMO/EPO or a DMO service area. For more information contact the Administrative Office.

Our next annual Open Enrollment period begins November 2016 for Plan changes effective January 1, 2017.  If you have moved out of your current Plan’s service area please contact the Administrative Office at (213) 386-8590 or (800) 293-1370

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