Health and Welfare FAQs

Plans available vary by state and are based on a participant’s active status, apprentice level and working area agreement. When you become eligible for benefits you will receive an enrollment packet with information on which plan options are available to you.

Anthem PPO participants covered under Express Scripts for prescription drugs. You may take your prescription to a participating pharmacy or you may use the Express Scripts Mail Order Pharmacy. However, only a CVS Pharmacy or the Express Scripts Mail Order Pharmacy can refill 90 day prescriptions for long-term medications. At any other retail pharmacy you will only be allowed to fill a 30 day supply of a long-term medication twice and thereafter you will be required to pay the full cost of the medication unless you opt for the 90 day supply through a CVS Pharmacy or the Express Scripts Mail Order Pharmacy (Long-term drugs are those you take regularly to treat an ongoing condition, such as high blood pressure or high cholesterol). Download, complete and mail theExpress Scripts Home Delivery Order Form. To contact Express Scripts, call (800) 987-7836 or visit www.expressscripts.com

If you are in the Kaiser HMO, your prescription drugs are covered by Kaiser. Refer to the benefit booklet issued by Kaiser on how to obtain prescription drugs or go to KP.org

Yes, during Open Enrollment you can switch dental plans if there are multiple dental plans available in your area.

Open Enrollment is in November each year with any plan changes being effective the 1st of January, provided you are eligible for coverage at that time. If you are enrolled in the Kaiser Medical Plan and have moved out of the plan’s service area, please contact the Trust Fund Office at (213) 386-8590 or (800) 293-1370.

The 1095-C is an 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 2, 2021; and,
  2. The IRS, no later than March 31, 2021 electronically.

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.

The 1095-B is an 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.

If you are an Anthem PPO participant you will receive your from 1095B from the CSAC Administrative Office. Kaiser Participants will receive their form directly from Kaiser Permanente.

A copy will be sent to…

  1. You (the H&W Participant) no later than March 2, 2021, and
  2. The IRS, no later than March 31, 2021electronically.

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. 

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 and Bronze 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. See LifeEvents.carpenterssw.org.

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.

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 in November when participants can change their plans for the coming year. An Open Enrollment packet will be sent to you in the mail with details regarding any plan changes in the next year the available plan options in your state.

Identification Cards are mailed directly from the plan you have selected. Please allow up to two weeks for your Identification Cards to be mailed to you.

Anthem Participants can go to Anthem.com/CA or download the Sydney Mobile App to sign up and access your insurance card and request a copy by mail or email.

Kaiser Participants can go to KP.org or download the Kaiser Mobile App.

UnitedHealthCare Participants can access ID cards at:

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

You may also locate a copy of your identification card from the insurance provider:

Anthem Participants can go to Anthem.com/CA or download the Sydney Mobile App to sign up and access your insurance card and request a copy by mail or email.

Kaiser Participants can go to KP.org or download the Kaiser Mobile App.

UnitedHealthCare Participants can access ID cards at:

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 to the Administrative Office 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 a copy of the 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. See LifeEvents.carpenterssw.org for more information.

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 or email Reciprocity@carpenterssw.org.

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 or email Reciprocity@carpenterssw.org.

If you were already enrolled in a medical or dental plan your plan choices will remain the same after Open Enrollment unless  you requested a change. If you are eligible and have not enrolled Medical or Dental Plan contact the Administrative Office for more information. 

In certain cases, if you are eligible for the Bronze Health Plan, you are automatically enrolled when you become eligible if your address is on file.

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 and the Summary Plan Description (SPD) for the Active or Bronze Plan.

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, breakdown per procedure, and the health provider’s name, address and telephone number.

The Trust only offers one Vision Plan to participants in the Active Plan. The Bronze Plan is excluded. Contact UnitedHealthcare toll free at (800) 638-3120 or visit their website at www.myuhcvision.com.

No, changes to your Plan can only be made within the Open Enrollment period unless you are enrolled in the HMO and relocate outside of the HMO service area. For more information contact the Administrative Office.

Studies show that people who have a trusting, ongoing relationship with one medical professional are more likely to be satisfied with their healthcare than people who do not.

  • If you are enrolled in the Anthem PPO, you do not need to choose a primary care physician (PCP), but you should—for help managing your care. To find an Anthem PCP for you and each of your enrolled dependents, visit anthem.com/ca or download the Sydney Mobile App and use the Find a Doctor tool.
  • If you are enrolled in the Kaiser HMO, Kaiser encourages you to choose a PCP for you and each of your enrolled dependents—to provide or coordinate all medical services. You are free to change doctors any time, for any reason. To find a Kaiser PCP, visit kp.org or download the Kaiser App and click “Doctors & Locations.”

Take these steps to help save on healthcare costs:

  • If you are enrolled in the Anthem PPO, use Anthem in-network doctors, hospitals, labs and other healthcare facilities. You will pay less, and you will not pay charges above the network contracted rate. (The Kaiser HMO pays benefits only for in-network care.)
  • Get a routine physical and immunizations in-network, every year. Most services are free to you. Simple tests can detect heart disease, high blood pressure, diabetes, certain cancers and more—often early enough to keep them from being serious health problems.
  • Use generic drugs whenever possible. Generics have the exact same active ingredients as their brand-name alternatives and are just as effective but, they cost you less than preferred or non-preferred brand name drugs. If your physician prescribes a brand name drug, ask if a generic is available.
  • Be sure to use mail order for prescriptions of more than 30 days. Under the Anthem PPO, after filling a long-term prescription drug twice at a participating retail pharmacy, you must fill your prescription for mail order through the Express Scripts Pharmacy or a CVS Retail Pharmacy. Otherwise, you will pay the full cost of the prescription.
  • Go to the emergency room only if it is a true emergency: when an illness or injury puts your life in serious jeopardy and treatment can’t be delayed. Otherwise, an urgent care center or your primary care provider is your best—and least expensive—option. Or visit a doctor online through Anthem’s LiveHealth Online or Kaiser’s My Doctor Online.

Yes!  You can use telemedicine for minor medical conditions and mental health services.

  • Anthem Participants (Active and Bronze) can use LiveHealth Online for a cost of $5 per visit with no deductible. Go to LiveHealthOnline.com or download the LiveHealth Online App and sign up. Be sure to use Anthem Blue Cross (CA) as the insurance company name. You can also input your preferred pharmacy.
  • Kaiser Participants can go to KP.org and choose Get Care for telephone, e-visit and video visit options.

Yes, you may enroll a Domestic Partner and the children of a Domestic Partner provided that you have properly registered your Domestic Partnership with the proper state or local authority and complete the enrollment paperwork. To add a Domestic Partner you will be required to pay the federal tax on the Domestic Partner’s premium on the Active Plan or the required Self-Payment for dependents on the Bronze Plan. See LifeEvents.carpenterssw.org for more information.

Marriage and Family Counseling is a covered benefit.

  • Anthem participants (Active and Bronze) are covered for up to 12 visits per enrolled participant when receiving counseling by a state licensed Psychologist, LMFT or LCSW.  Costs are subject to the co-pay or deductible and coinsurance required by the plan you are enrolled in.
  • Kaiser Participants are covered for Marriage and Family Counseling if at least 1 family member who is receiving the counseling has a clinical diagnosis and a referral from a Kaiser physician