2019 Open Enrollment Healthcare Benefit Changes

General

Effective January 1, 2019, the Trust Fund is introducing a new, enhanced Anthem Preferred Provider Organization (PPO). This plan will replace the UnitedHealthcare (UHC) Exclusive Provider Organization (EPO) and UHC PPO, Anthem PPO and all Health Maintenance Organizations (HMOs) in all states except the Kaiser HMO in California and Colorado. Under the enhanced Anthem PPO, prescription drug benefits will be administered through Express Scripts (ESI), a pharmacy benefit administrator that is separate from your medical plan. Also, the Trust Fund is making some changes to the Kaiser HMO and introducing new, enhanced UnitedHealthcare dental plan options, a copayment plan and a Dental Preferred Provider Organization (DPPO). These new UnitedHealthcare dental plans will replace all current dental plan options. Note that the copayment plan will not be available in New Mexico or Texas.

The plans available to you in 2019 will depend on the state in which you live and the plan you are currently in:

  • If you live in any state other than California and Colorado, you will be enrolled automatically in the new, enhanced Anthem PPO effective January 1, 2019.
  • If you live in California or Colorado and are:
    • Currently enrolled in the Kaiser HMO, your coverage for 2019 will continue in the Kaiser HMO automatically, unless you elect the enhanced Anthem PPO during Open Enrollment, for coverage effective January 1, 2019.
    • Not currently enrolled in the Kaiser HMO, you will be enrolled automatically in the enhanced Anthem PPO for 2019, unless you elect the Kaiser HMO during Open Enrollment, for coverage effective January 1, 2019.
  • If you are eligible but not currently enrolled in any medical plan through the Southwest Carpenters Trust Fund, you will need to complete an enrollment form to enroll in a medical plan available to you effective January 1, 2019.

The Trust Fund is making every effort to manage rising medical and prescription drug costs while providing competitive benefits. The new, enhanced Anthem PPO will help manage costs because it will be self-funded.

How does self-funding reduce the Trust Fund’s costs? To keep it simple, insurance carriers generally collect more in premiums than what they pay in claims and they retain the difference as their profit. By eliminating the other plans, we will no longer be paying high insurance premiums to insurance carriers, and instead we will keep the money in the Trust Fund and issue benefit payments from our Trust Fund account. We will still have to pay Anthem a modest per-participant fee to process claims for us, but the net result is significant savings to the Trust Fund. The Trust Fund will also save on Affordable Care Act fees that are currently paid to the insurance carriers (estimated to be $4.5 million this year alone).

These savings will help the Trust Fund better manage rising costs and continue to offer competitive healthcare coverage in the coming years.

The Trust Fund will continue to offer the Kaiser HMO in California and Colorado because Kaiser:

  • Has a large provider network (most HMOs don’t), so there are lots of doctors, hospitals, labs and other healthcare facilities to choose from,
  • Has their own pharmacy (which saves you money), plus Kaiser pharmacies are conveniently located in their medical buildings, so you avoid a trip to a retail pharmacy, and
  • Is a non-profit organization, so the Trust Fund pays lower Affordable Care Act fees (required by the federal government).

The way your medical coverage will be affected in 2019 will depend on the plan you are currently in and the state in which you live. Find your current medical plan in the list below:

  • Current Anthem PPO: This is an Anthem plan, so your benefits will improve with the new, enhanced Anthem PPO. You also have the option to change to the Kaiser HMO during Open Enrollment if you live in California or Colorado.
  • Kaiser HMO: You can stay covered under the Kaiser HMO (you’ll remain enrolled automatically) or you can change to the enhanced Anthem PPO. There are some enhancements and changes to Kaiser HMO coverage as well.
  • Anthem Blue Cross & Blue Shield HMO, Health Plan of Nevada HMO, Select Health HMO or UnitedHealthcare HMO: These plans will no longer be offered and you will be enrolled automatically in the new Anthem PPO. If you live in CA or CO, you will also have Kaiser HMO as an option. Depending on where you live, you may have to change doctors if your current doctor is not in the enhanced Anthem PPO network. However, Anthem has a large network, so you’ll have many providers to choose from. Also, under the Anthem PPO, the way you pay for medical services will change. For example, you’ll pay a percentage of the cost instead of a copay for many services. This means you may pay more out-of-pocket if you need care. In addition, your prescription drug benefits will be administered through Express Scripts (ESI), a pharmacy benefit administrator that is separate from your medical plan. This means you may need to change your prescriptions to keep your costs similar to what you pay now. For more information, see "New Anthem PPO" and "Prescription Drug Benefits," below.
  • UnitedHealthcare EPO or PPO: These plans will no longer be offered and you will be enrolled automatically in the new Anthem PPO. If you live in CA or CO, you will also have the Kaiser HMO as an option. It’s likely that the network providers you use now are in Anthem’s PPO network. That means it’s likely that you will not have to change doctors. However, some out-of-pocket costs and covered expenses may be different under the enhanced Anthem PPO. And, you’ll have a different prescription drug plan administrator—Express Scripts. This means you may need to change your prescriptions to keep your costs similar to what you pay now. For more information, see "New Anthem PPO" and "Prescription Drug Benefits," below.

It will depend on the plan you are currently in and the state in which you reside:

  • Current Anthem PPO: You do not need to take any action, except to get familiar with the enhanced benefits and services offered by the new, enhanced Anthem PPO so you can take advantage of them. You’ll be enrolled automatically in the enhanced Anthem PPO. If you live in California or Colorado, you have the option to enroll in the Kaiser HMO.
  • Kaiser HMO: You do not need to take any action unless you want to change to the Anthem PPO. In that case, you’ll need to enroll during Open Enrollment, find a new in-network doctor and get familiar with the benefits and services offered by the Anthem PPO so you can take advantage of them.
  • Anthem Blue Cross & Blue Shield HMO, Health Plan of Nevada HMO, Select Health HMO or UnitedHealthcare HMO, EPO or PPO: You do not need to take any action; you’ll be enrolled automatically in the enhanced Anthem PPO. However, if you live in California or Colorado, you have the option to enroll in the Kaiser HMO during Open Enrollment. If you are enrolled in the new Anthem PPO:
    • You’ll need to find out whether your current doctor is in the Anthem network. If he or she isn’t and you want to see a network doctor, you need to choose a new doctor. Anthem has tools to help you do this. If you see an out-of-network provider after January 1, 2019, you will pay more for your out-of-pocket medical costs.
    • If you’re being treated for an acute medical condition or serious chronic condition and your providers aren’t in Anthem’s network, Anthem has a dedicated team to help you transition your care to network providers. See "How will Anthem's Transition of Care work?" below.
    • You’ll also need to check to see whether your prescription drugs are included in the Express Scripts formulary (the list of covered prescription drugs). If you need to make a prescription drug change, contact your doctor to discuss alternative/preferred formulary medications.
  • Eligible but NOT currently enrolled in any medical plan through Carpenters Southwest Administrative Corporation as of October 31, 2018: You will need to complete an enrollment form if you want to enroll in a medical plan effective January 1, 2019. Enrollment is required even if there is only one plan available in your state.

New Anthem PPO

A PPO, or Preferred Provider Organization, is a group of providers (doctors, hospitals, labs and other healthcare facilities) that have contracted with Anthem to charge discounted fees for their services.

“In-network” providers are doctors, hospitals, labs and other healthcare facilities that have contracted with Anthem to charge discounted fees for their services. “Out-of-network” providers have no agreement with Anthem and may charge any amount they want, which may be significantly higher. Services received from an in-network provider will always cost you less. See the example below.

The following example shows the cost of in-network vs. out-of-network hospital care for an outpatient procedure and assumes the annual deductible has been met.

 

In-Network Hospital Out-of-Network Hospital
Hospital expenses for a one-day outpatient hospital procedure $10,000 (reflects PPO in-network discounted fee) $15,000 (no discount)
Plan pays
You pay
$9,000 (90%)
$1,000 (10%)
$7,500 (50%)
$7,500 (50%)

In this example, you save $6,500 by using an in-network hospital.

If you are currently in the Anthem PPO, your out-of-pocket costs will decrease under the new Anthem PPO. If you are currently in an EPO or non-Anthem PPO, your deductible and out-of-pocket maximum will be higher under the new Anthem PPO; other benefits may have higher or lower costs. If you are currently in an HMO, you may pay more out-of-pocket under the new Anthem PPO. Anthem has online tools you can use to find the best care at the lowest cost.

With an HMO, you choose a primary care physician (PCP) and can only see providers who participate in the plan’s network. The Anthem PPO is more flexible. It doesn’t require you to choose a PCP. It also offers out-of-network coverage for providers who aren’t in Anthem’s PPO network, although your out-of-pocket costs will be greater when you use an out-of-network provider.

Also, the Anthem PPO is different in how it covers medical care. For most covered expenses, you pay a calendar year deductible before the PPO starts paying benefits. Then, you and the PPO share expenses (called “coinsurance”) until you reach the plan’s calendar year out-of-pocket maximum. At that point, the PPO pays 100% of covered expenses for the rest of the calendar year.

IMPORTANT: The PPO pays 100% of the cost of in-network routine preventive care (like your annual physical) and related lab fees and tests with no deductible.

The types of care under the Anthem PPO are the same as what is under the Trust Fund’s current medical plans.

This is the amount that Anthem will use to determine benefit payments for care or services received from out-of-network providers who can charge any amount they wish to charge. You are responsible for paying any amounts over Anthem’s allowed amount for a given service or procedure.

Whether you can keep seeing your current provider and receive in-network benefits in the coming year will depend mainly on where you live:          

  • All states except Nevada and Utah: Anthem has a large provider network, so it is likely that your current provider participates in the Anthem PPO network. However, if you will be enrolled in the Anthem PPO, confirm your provider is in the Anthem network before your first visit on or after January 1, 2019. If you need to choose a new network provider, Anthem offers online tools to help you find one (visit anthem.com/ca). Also, Anthem has a dedicated team to help transition certain care from a non-network provider to a network provider.
  • Nevada and Utah: Although Anthem has a large provider network, if you participate in the Health Plan of Nevada HMO or Select Health HMO, your current provider may not participate in the Anthem PPO network. You may need to select a new, in-network provider to receive the higher in-network benefits. Of course, you may continue to see your current provider. However, you will pay more for out-of-network care.

If you will be enrolled in the Anthem PPO and you’re currently receiving certain kinds of care from a provider who’s not in Anthem’s network, your eligible claims will be processed at the out-of-network level of benefits. However, you may be eligible for the Continuity of Care/Transition of Care Assistance Program. This program is available if you meet certain criteria:

  • You are in an active course of treatment for an acute medical condition or a serious chronic condition:
    • An acute medical condition means the sudden onset of symptoms from an illness, injury or other medical problem that requires prompt medical attention and lasts for a limited time.
    • A serious chronic condition means a disease, illness or other medical problem (such as cancer) that is serious and continues without getting better completely or worsens, or requires ongoing treatment to keep it from happening again or prevent it from getting worse.
  • You are in an active course of treatment for any behavioral health condition,
  • You are pregnant,
  • You have a terminal illness,
  • You have a newborn child between the ages of birth and 36 months, or
  • You have a surgery or other procedure that has been authorized by your current plan or its delegated provider and is scheduled to occur within 180 days after December 31, 2018.

If you think you may be eligible for this program, complete a Continuity/Transition of Care Request Form (available under General Forms and Documents starting November 1) or from Anthem Customer Service at (877) 359-9644.

If your transition request is approved, Anthem will cover you at the higher in-network benefit level until treatment with your current physician concludes or you can safely move to Anthem network providers. If your out-of-network provider accepts Anthem’s in-network rate, you must pay any deductibles or coinsurance that apply.

If your out-of-network provider does not accept Anthem’s in-network rate, you will not receive transition assistance. You are responsible financially if you choose to continue with out-of-network care. This may result in significant out-of-pocket expenses.

Visit anthem.com/ca to search for providers online, then:

  • If you’re not in the Anthem PPO yet, select the “Individual and Family” tab, then choose “Find a Doctor” under the “Care” column. Scroll down to “Identification Number/Alpha Prefix.” Enter “EFW” then click “Continue.” Next, select the type of doctor, area of specialty and location, plus the name of the doctor or medical professional, if available. Then select “Search.”
  • If you’re a participant and have registered for the website, log in, then, under “Useful Tools” on the right, select “Find a Doctor.” Select the type of doctor, area of specialty and location, plus the name of the doctor or medical professional, if available. Then select “Search.”

You may also download Anthem’s mobile app from the App Store or Google Play and use the provider search tool, or call Anthem for help finding an in-network provider, at (833) 224-6930.

Ask your doctor to contact Anthem directly. Anthem will email an application packet to the doctor’s office. If the doctor returns the application to Anthem, they will initiate a credentialing review to ensure that the doctor meets their guidelines. This review takes 60 to 90 days to complete. Anthem does not guarantee the addition of any doctors, since acceptance into the network is dependent on the credentialing review and network needs.

See the 2019 Benefits Comparison Charts that contain information on the Anthem PPO. Summaries of Benefits and Coverage (SBCs) will also be available on this website by November 1.  In addition, a home mailer was sent to you in late August with details on the new Anthem PPO coverage. Also, you can call Anthem directly for coverage details or contact Participant Services at the Trust Fund at (213) 386-8590 or (800) 293-1370.

Anthem in-network providers can only charge you for copays or services not covered by the plan at the time of service. They cannot charge you deductible or coinsurance amounts until your claim is processed and Anthem’s Explanation of Benefits (EOB) is sent to you. For example, if you have an office visit with an Anthem PPO doctor, the doctor’s office cannot charge you for the deductible and 10% coinsurance until you receive your EOB. However, if the doctor performs a service not covered by the plan such as a Botox injection, the doctor’s office can charge you for that service at the time you receive it since it is not covered under the plan.

For most covered in-network services, the plan will pay 90% of the discounted network charge. For most covered out-of-network services, the plan will pay 50% of the allowed amount. This is the amount that the Anthem PPO allows as payment for care or services received from out-of-network providers. Your cost-share is determined using the allowed amount, not the total charge or billed amount. For details, see "What does the term “allowed charge” or “allowed amount” mean?" above.

Yes. Once you are enrolled in the new Anthem PPO, register to use the Anthem website at anthem.com/ca. You can then use the “Estimate Your Cost” tool to compare costs and quality for common procedures before you have those procedures/services performed.

No. You may see a specialist without the need for pre-approval or a referral. However, you will receive the highest level of benefits by choosing an in-network specialist.

The Anthem PPO provides:

  • A large, nationwide network of doctors, hospitals, labs, and other healthcare facilities to choose from,
  • The ability to see any doctor and receive plan benefits for covered care (but you’ll get greater benefits if you use an in-network provider),
  • The flexibility to see a specialist without a referral,
  • Coverage available even if you are away from home,
  • Services and tools that help you navigate the healthcare system, pay less and get more, and receive care more conveniently, such as seeing a doctor online through LiveHealth Online, and
  • A mobile app to get benefits information, manage claims, find providers and get a new ID card. Once you’re enrolled, visit the App Store or Google Play to download the app.

In addition, Anthem offers the following special services:

  • Estimate Your Cost Tool: helps determine the cost of medical procedures,
  • Anthem HealthGuide: customer service team trained to help you navigate the healthcare system,
  • Anthem’s Blue Distinction Centers: healthcare facilities that specialize in cardiac care, cancer treatments, transplants and spine surgery, for higher quality care, faster recovery and fewer health complications,
  • LiveHealth Online: see a US-based doctor 24/7/365 on your phone, tablet or computer for things like a sore throat, ear pain, cough, flu, pink eye and more,
  • 24/7 Nurseline: access to trained, Registered Nurses 24/7/365 for advice about common health issues,
  • Future Moms Program: pairs moms-to-be with a nurse-specialist pregnancy coach to manage screenings, discuss nutrition and prepare for delivery,
  • ComplexCare: access to trained nurse care managers who work with higher-risk patients with serious orthopedic, heart, nerve, cancer-related and other major health issues (and their doctors) to make a personal nursing care plan,
  • ConditionCare: 24/7 condition management assistance from nurse coaches and Registered Nurses for certain types of cancer, vascular or musculoskeletal diseases, asthma, diabetes, chronic obstructive pulmonary disease (COPD), heart disease, depression and more,
  • MyHealth Advantage Gold: sends you messages about opportunities to improve your health, spend your healthcare dollars more effectively and avoid critical health issues, and
  • AIM: Program that ensures procedures your doctor requests are appropriate and that you receive the right level of care.

Call Anthem Member Services at (833) 224-6930 for more information or to register for these special services.

Telemedicine is a service that lets you see a US-based, board-certified doctor 24/7 via video chat on your phone, tablet or computer, through Anthem’s LiveHealth Online service. Use this service to diagnose common conditions—like a sore throat, headache, or the flu—or get answers to medical questions. Effective January 1, 2019, visit livehealthonline.com for more information and to enroll. You only need to pay a $5 copay for each LiveHealth Online visit.

Under the Anthem PPO, most common preventive services and tests are covered at 100% with no copay or deductible when received from an in-network provider. These include:

  • Annual wellness exams, including doctor’s office visits and any required diagnostic or laboratory testing,
  • Immunizations,
  • Colorectal cancer screenings,
  • Well-woman exams, including screenings for cervical and breast cancer,
  • Child and adolescent preventive care, including well-baby and well-child exams,
  • Alcohol and drug abuse screenings, and
  • Certain preventive medications.

Visit anthem.com/ca for more information and a complete list of covered preventive care services.

The annual deductible under the Anthem PPO depends on whether you receive services in-network or out-of-network. The in-network deductible is $300 per person, with a maximum of $900 per family. For out-of-network services, the annual deductible is $500 per person, with a maximum of $1,500 per family.

Generally yes, but it depends on the service or care you are receiving. Eligible preventive care services received in-network are covered at 100% with no deductible. In addition, you do not have to pay the annual deductible before the plan starts paying outpatient prescription drug benefits or if you need ambulance services. However, for most other types of services and care, including doctor and specialist visits, you must meet the annual deductible before the plan starts paying benefits.

If you or your dependents are covered under a Trust Fund plan and another group medical plan, benefits will be coordinated between the plans on a “non-duplication” basis. It is not intended that you receive greater benefits than the actual allowable charges you incur. For details and rules for coordination of benefits, see the Health and Welfare Trust Summary Plan Description.

The annual out-of-pocket maximum under the Anthem PPO depends on whether you receive services in-network or out-of-network. Once you’ve met the annual individual out-of-pocket maximum, the plan will begin paying 100% of eligible charges for that individual. The annual medical in-network out-of-pocket maximum is $2,500 per person with a maximum of $5,000 per family. The annual outpatient prescription in-network out-of-pocket maximum is $1,000 per person with a maximum of $2,000 per family. There is no out-of-pocket maximum for out-of-network services, except for emergency care in an emergency room.

Yes. Emergency services are covered whether you use an in-network or out-of-network provider. However, out-of-network providers may charge for expenses that are not covered or charge more than the plan’s allowed charge and the charges will be paid at the out-of-network level if it’s deemed not to be a true emergency (see "What does the term “allowed charge” or “allowed amount” mean?" above). So it’s a good idea to receive in-network care whenever possible.

Yes. You’re covered through the BlueCard® program to get care anywhere in the United States and worldwide, as described in your Summary of Benefits and Coverage, but claims are processed at the out-of-network level. For more information, visit anthem.com/ca.

After you receive care from an in-network or out-of-network provider, you will receive an EOB statement from Anthem. This is not a bill. It’s a document showing the amount the provider charged, how much of that amount is allowable under the plan, how much the plan paid to the provider and the amount you owe the provider, if applicable. Your EOB statement will also show how much you’ve paid toward your annual deductible. EOBs are sent to you automatically when your provider files a claim for service. You can also see your EOBs online by registering at anthem.com/ca.

HealthGuide is Anthem’s new, enhanced customer service model. It provides tools to help you get the care that’s right for you and get more value from your benefits. Anthem offers specially trained health guides who can:

  • Connect you with healthcare programs and support,
  • Spot gaps in your medical care, such as routine exams and screenings,
  • Help you save money on prescription drugs, and
  • Compare costs and find in-network providers.

Call Anthem’s HealthGuide, at (833) 224-6930.

Kaiser HMO

Yes, if you are currently enrolled in the Kaiser HMO, you will be enrolled automatically in the Kaiser HMO for 2019. However, you have the option to elect coverage under the new Anthem PPO effective January 1, 2019 if you enroll for coverage during the Open Enrollment period, from November 1 through 21, 2018, by completing an Anthem BlueCross enrollment form.

Kaiser HMO coverage will change as outlined below. The increase in the annual out-of-pocket maximum makes it the same as the Anthem PPO. With a new deductible being added to the Kaiser plan, members will begin to receive an Explanation of Benefits (EOB) statement monthly showing their deductible and out-of-pocket balance.

Feature Current Kaiser HMO Kaiser HMO
Effective January 1, 2019

Doctor office visit copays (decrease)

CA: $20

CO: $20 plus 10% for procedures performed

CA and CO: $10

Specialist office visit copays (decrease)

CA: $40

CO: $30 plus 10% for procedures performed

CA and CO: $20

Annual out-of-pocket maximum (increase)

CA: $1,500 per person/
$3,000 family maximum

CO: $2,000 per person/
$4,000 family maximum

CA and CO: $2,500 per person/$5,000 family maximum

Calendar year deductible for inpatient hospital, outpatient hospital and emergency room services (new)

None

CA and CO: $300 per person/ $600 family maximum

Inpatient hospital, outpatient hospital and emergency room services

CA and CO: various copays

CA and CO: 10% after annual deductible

Prescription drugs: Preferred Brand Retail — up to 30-day supply

CA: $35

CO: $30 Preferred;
$50 Non-Preferred

CA and CO: $30

Prescription drugs: Preferred Brand Mail Order (decrease in CA)

CA: $70 up to 100-day supply

CO: $60 up to 90-day supply

CA: $60 up to 100-day supply

CO: $60 up to 90-day supply

There are also improvements to prescription drug copays under the Kaiser HMO in California. Retail Preferred Brand, Non-Preferred Brand, and Specialty copays will decrease from $35 to $30 with no deductible (up to a 30-day supply). Mail order Preferred Brand and Non-Preferred Brand will decrease from $70 to $60 with no deductible (for up to a 100-day supply). Generic drug copays will continue to be $10.

The first difference relates to how each plan provides care. Under the Kaiser HMO, benefits are not paid for care provided from non-Kaiser network providers (except in cases of life-threatening emergency). Kaiser encourages members to choose a personal physician who will provide or coordinate all medical services. You’re free to change doctors within the Kaiser network any time, for any reason. In most cases, you’ll need to obtain a referral from your Kaiser personal physician to see a Kaiser specialist. You don’t need a referral for certain specialties, like obstetrics-gynecology, optometry, most psychiatry and substance abuse disorder treatment. With the Anthem PPO, you are not required to choose a primary care physician, and you can make an appointment directly with a specialist. You can also see providers outside Anthem’s network and receive benefits from the plan at the out-of-network level.

The second difference relates to your out-of-pocket costs for care. Under the Kaiser HMO, there is an annual deductible for certain services and you pay a flat copay for most covered services. For most covered services under the Anthem PPO, you must pay an annual deductible before the plan starts paying benefits. Then, you and the PPO share expenses (called “coinsurance”) until you reach the annual out-of-pocket maximum. At that point, the PPO pays 100% of covered expenses for the rest of the calendar year for the individual who reached the maximum. The Anthem PPO and the Kaiser HMO both pay 100% of the cost of in-network routine preventive care (like your annual physical) and related lab fees and tests, and no deductible applies to these services.

For 2019, there will be a new annual deductible under the Kaiser HMO for inpatient hospital stays, outpatient hospital visits and emergency room visits: $300 per person, with a maximum of $600 per family.

The annual out-of-pocket maximum under the Kaiser HMO will be $2,500 per person with a maximum of $5,000 per family—the same as it will be under the Anthem PPO.

In Southern Colorado, Kaiser members can use any pharmacy, not just Kaiser. For long-term drugs, you can use an outside pharmacy only once, then you must use a Kaiser pharmacy or the Kaiser mail order program. In other areas of Colorado and in California, you can use a Kaiser pharmacy or the Kaiser mail order program for long-term drugs.

Prescription Drug Benefits

If you are enrolled in the new Anthem PPO, your prescription drug benefits will be administered by Express Scripts (ESI). If you are enrolled in the Kaiser HMO, your prescription drug benefits will be administered by Kaiser.

You may take your prescription to a pharmacy that participates in Express Scripts’ network (for example, national chains like Sav-On, Smith’s, Safeway, CVS; regional drug store chains; and thousands of independently-owned pharmacies). However, after two fills, you need to use the Express Scripts PharmacySM mail order service for drugs to be taken for 31 days or more. To determine if your prescription is covered, how much is covered, if you need to get prior authorization before filling your prescription or you have other questions about your prescriptions, contact Express Scripts at expressscripts.com or (800) 987-7836.

Yes. You may fill a long-term prescription drug at a participating retail pharmacy up to two times (an initial fill and one refill). After that, you must fill your prescription through the Express Scripts Pharmacy mail order service. If you continue filling the prescription at a retail pharmacy, you’ll pay the entire cost of the drug. (Long-term drugs are those prescribed by your doctor for ongoing conditions, such as high blood pressure or high cholesterol.)

When you fill your prescription by mail order, you can save up to 60% on the cost and your medication will be delivered to your home with free standard delivery.

To get started with mail order as of January 1, 2019, call Express Scripts at (800) 987-7836. For most medications, they will contact your doctor and arrange for your first home delivery supply. Your medication will usually arrive within eight to 11 days after your prescription is received. Continue to use a participating retail pharmacy to fill prescriptions for short-term drugs, such as antibiotics.

If the drug you are taking is not on Express Scripts’ formulary, contact your doctor to discuss alternative/Preferred medications or request a formulary coverage review by calling Express Scripts’ Coverage Review Department at (800) 753-2851.

Have your network doctor write a new long-term prescription and submit it to Express Scripts (for the new Anthem PPO) or Kaiser (for the Kaiser HMO) as soon as possible after December 31, 2018. Your doctor can also write a short-term prescription, to fill at your local in-network retail pharmacy, to cover you while you are waiting for your mail order medications to arrive.

Have your Anthem participating doctor write a new 90-day prescription and submit it to Express Scripts as soon as possible after December 31, 2018. Your physician can write an emergency short-term prescription, to fill at your local in-network retail pharmacy, to cover you while you are waiting for your mail order medications to arrive.

New Dental Plans

Yes. Depending on where you live, you will be enrolled automatically in a new UHC copayment plan or the UHC Dental PPO (DPPO). You may also have the ability to choose between the two dental options. See the chart below for details.

If You… Here’s What Will Happen…
Are now in any Southwest Carpenters Trust Fund dental plan and living in California or Nevada You’ll be enrolled automatically in the UHC Select Managed Care Direct Compensation (DC) Plan for coverage effective January 1, 2019. Or, you can choose the UHC DPPO during Open Enrollment for coverage effective January 1, 2019.
Are now in any Southwest Carpenters Trust Fund dental plan and living in any state EXCEPT California or Nevada You’ll be enrolled automatically in the UHC In-Network Only (INO) Plan for coverage effective January 1, 2019.* Or, you can choose the UHC DPPO during Open Enrollment for coverage effective January 1, 2019.
Are not in any Southwest Carpenters Trust Fund dental plan as of October 31, 2018 You’ll need to complete an enrollment form if you want to enroll in a dental plan effective January 1, 2019.

* Note that the UHC INO is not available in Alaska, Alabama, Arkansas, Connecticut, Georgia, Hawaii, Idaho, Illinois, Kansas, Kentucky, Louisiana, Maryland, Maine, Missouri, Mississippi, Montana, New Mexico, North Carolina, North Dakota, Oklahoma, Texas and Vermont. If you live in any of these states, you will be enrolled automatically in the UHC DPPO for coverage effective January 1, 2019.

The new dental plans offer these enhancements over the current dental plans:

  • For 2019, in most states you will have a choice between a UHC copayment plan and the UHC DPPO.
  • Under the copayment plans, your copays for most dental services will be either the same as or less than the copays under the current DHMOs.
  • Under the new DPPO, you pay a percentage of the cost for dental services instead of copays. Also, you can choose from a larger network of dentists than under the current DHMOs and new copayment plans. It’s likely that the network dentists you use now are in the DPPO network. In addition, the DPPO gives you access to out-of-network dentists.
  • All of these UHC dental plans pay for diagnostic and preventive services at 100%.

Orthodontic treatment in progress is prorated based on the initial date of service and expected timeframe of the treatment. Banding charges and monthly fees incurred before the effective date with UnitedHealthcare would be paid by your prior dental plan. UnitedHealthcare would review the full cost of the case and the remaining treatment to be completed after you change to UnitedHealthcare to calculate the benefit that will be paid over the remaining months of treatment.

If you are in the middle of an extensive treatment plan, a transition to a new carrier can be concerning. Often a pretreatment estimate was completed by your prior carrier. Ask your dentist to submit a similar pretreatment claim to UnitedHealthcare, listing the remaining services to be completed with any supportive x-rays or documentation. This gives UnitedHealthcare the opportunity to assist you with the transition before the work is completed. UnitedHealthcare also encourages provider nominations to its network and would be happy reach out to your dentist if he or she is not in their network. Nominations can be submitted online at myuhc.com or by calling the customer service number on your ID card.

Vision Plan

No. Your vision benefits are not affected by the changes to your medical, prescription drug and dental plans. They will continue to be administered by UnitedHealthcare. You automatically have vision benefits if you are enrolled in a medical plan.

Enrollment

Enroll by visiting the Trust Fund website after November 1, select the Open Enrollment page and print the enrollment application(s) available under the Health and Welfare tab for the plan you wish to select. Complete your enrollment form and submit it to the Trust Fund office by November 21. You can also call the Trust Fund Office to request enrollment materials. The elections you make during this Open Enrollment period (November 1 through November 21) take effect January 1, 2019.

Generally, you can’t change your coverage other than during Open Enrollment unless you have a qualifying event (for example, marriage, divorce, birth or adoption of a child) or, if you are a Kaiser participant, you move outside of a Kaiser service area.

Your new ID card(s) will be mailed to your home address on file. If you don’t receive your ID cards by January 1, 2019, you may be able to print them from the Kaiser or Anthem website depending on which plan you are enrolled in effective January 1, 2019. Or, call Kaiser or Anthem directly to request them.

Our next annual Open Enrollment is November 1 through November 21, 2018 for plan changes effective January 1, 2019. If you have moved out of your current plan’s service area, please contact the Trust Fund Office at (213) 386-8590 or (800) 293-1370.

Changes made during the upcoming Open Enrollment period take effect January 1, 2019.

The Trust Fund is making changes to medical, prescription drug and dental plan coverage effective January 1, 2019. Whether you can keep your current healthcare plan and what you need to do depends on what plan you are in now and where you live. See Open Enrollment for details.

This information describes medical coverage in effect through December 31, 2018. For information on medical coverage in effect starting January 1, 2019, see Open Enrollment. If you reside within our HMO/EPO service area, you must enroll in an HMO/EPO Plan for coverage during 2018. If your primary residence is outside an HMO/EPO service area, the Fee-For-Service PPO Plan is available for 2018.

No, unfortunately if you missed the annual Open Enrollment period you can no longer make changes until the next annual Open Enrollment period. The exception to this rule is if you move outside of your current Health Plan’s service area.

If you are eligible during the Open Enrollment period, you will receive a notice from the Administrative Office with instructions on how to enroll. Our next annual Open Enrollment period is from November 1st through November 21st, 2018, for plan changes effective January 1, 2019. 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.

No, parents are not eligible to enroll on your Health Plan. For more information contact the Administrative Office at (213) 386-8590 or (800) 293-1370.

You are allowed to add or drop a dependent during the Plan year if you have a qualifying life event such as a birth, marriage, divorce or your spouse loses their coverage. If you are adding a dependent you will be required to complete an Enrollment Change Form, obtainable through the Administrative Office or this website.  You must add or drop your dependents within 30 days of the qualifying life event.

In general, you can change your health plan provider once a year during the annual Open Enrollment period. However, depending on what state you live in, you may only have one medical and/or dental plan option. See Open Enrollment 2019. You can, however, change your medical primary care physician or your dental office during the calendar year.

No, as long as you are eligible for Plan benefits based on Active work hours these benefits are offered to you at no cost. If you lose coverage you will be offered COBRA Continuation of Coverage, which you will be required to submit monthly premiums to the Administrative Office to continue your healthcare. 

Yes, this is considered a life event and you are eligible to add your dependent within 30 days from the birth. Contact the Administrative Office to obtain the Enrollment Forms to add your new dependent.

Yes, if you are the legal guardian or awarded legal custody of your siblings, they may be considered eligible dependents.  For more information please contact the Administrative Office at (213) 386-8590 or (800) 293-1370.

Yes, you can cover your dependent child up to the age of 26 if you have provided the Administrative Office with all the required documentation.

No, unfortunately if you missed the annual Open Enrollment period you can no longer make changes until the next annual Open Enrollment period. The exception to this rule is if you meet the 1,380 hours requirement for the current plan year, are enrolled in the Kaiser HMO in Colorado and move outside of Kaiser's service area.

Our next annual Open Enrollment is November 1 through November 21, 2018 for plan changes effective January 1, 2019. If you have moved out of your current plan’s service area, please contact the Trust Fund Office at (213) 386-8590 or (800) 293-1370.

Changes made during the upcoming Open Enrollment period take effect January 1, 2019.

The Trust Fund is making changes to medical, prescription drug and dental plan coverage effective January 1, 2019. Whether you can keep your current healthcare plan and what you need to do depends on what plan you are in now and where you live. See Open Enrollment 2019 for details.

In general, you can change your medical plan once a year during the annual Open Enrollment period. However, depending on what state you live in and your active status, you may only have one medical and/or dental plan option. See Open Enrollment 2019. You can, however, change your medical primary care physician or your dental office (if applicable) during the calendar year.

No, unfortunately if you missed the annual Open Enrollment period you can no longer make changes until the next annual Open Enrollment period. The exception to this rule is if you meet the 1,380 hours requirement for the current plan year, your agreement provides for contributions to the Gold Plan and you are enrolled in the Kaiser HMO in Colorado and move outside of Kaiser's service area.

If you are eligible during the Open Enrollment period, you will receive a notice from the Administrative Office with instructions on how to enroll. Our next annual Open Enrollment period is from November 1st through November 21st, 2018, for plan changes effective January 1, 2019. 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.

No, parents are not eligible to enroll on your Health Plan. For more information contact the Administrative Office at (213) 386-8590 or (800) 293-1370.

Yes, you can cover your dependent child up to the age of 26 if you have provided the Administrative Office with all the required documentation.

Yes, if you are the legal guardian or awarded legal custody of your siblings, they may be considered eligible dependents.  For more information please contact the Administrative Office at (213) 386-8590 or (800) 293-1370.

Yes, this is considered a life event and you are eligible to add your dependent within 30 days from the birth. Contact the Administrative Office to obtain the Enrollment Forms to add your new dependent.

You are allowed to add or drop a dependent during the Plan year if you have a qualifying life event such as a birth, marriage, divorce or your spouse loses their coverage. If you are adding a dependent you will be required to complete an Enrollment Change Form, obtainable through the Administrative Office or this website.  You must add or drop your dependents within 30 days of the qualifying life event.

Contact the Administrative Office to verify your mailing address.  If your mailing address is not correct, you will need to submit your change of address in writing including your signature to the Administrative Office. If your address is correct, you can contact your Health Plan provider and request a new card.

No, as long as you are eligible for Plan benefits based on Active work hours these benefits are offered to you at no cost. If you lose coverage you will be offered COBRA Continuation of Coverage, which you will be required to submit monthly premiums to the Administrative Office to continue your healthcare. 

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