IMPORTANT UPDATES


REGISTER AN ACCOUNT AND LOGIN TO SUBMIT FORMS ELECTRONICALLY AND ACCESS THE FOLLOWING:

-Health Fund Hour Bank Detail

-Pension Hours and Credits



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Form 1095-B Information

FORMS


Family Update Form

If you have a life-changing event and need to update dependent information, this form must be completed and sent to the Fund Office, with the appropriate documentation (birth certificate, marriage certificate, divorce decree, etc.).

Change of Name Form

Complete this form to change or correct your name, and return it to the Fund Office.

Change of Address Form

Complete this form to change or correct your mailing address and/or name, and return it to the Fund Office.

Authorization for Release of PHI Form

If you want the Plan to disclose your protected health information to another individual(s), persons, class of persons, or organization of your choice (for example, your spouse), you must fill out this form and return it to the Fund Office. If your spouse and/or Dependent child(ren) over the age of 17 (i.e. Dependent child(ren) who are at least 18 years old) want the Plan to disclose their protected health information to you, they also must fill out this form and return it to the Fund Office.

Accident Injury Form

Complete this form to acknowledge the Fund’s subrogation and reimbursement interests. For more information, please contact the Fund Office.

Short Term Disability Form

If you become disabled and are unable to work, you and your physician must complete this form and submit it to the Fund Office, in order to receive the weekly disability benefits.

Parental Leave Benefit Application

If you are an active Group I employee and you are taking a leave of absence following the birth, adoption or placement of adoption, you may be entitled to parental leave benefits. Complete this Form to apply and submit it to the Fund Office.

Pregnancy Leave Benefit Application

If you are an active Group I employee and become pregnant, you may be entitled to up to 26 weeks of pregnancy leave benefits. Complete this Form to apply and submit it to the Fund Office.

Local 294 Vacation ACH Authorization Form

Complete this form if you are a Local 294 member and would like to have your vacation payments directly deposited to your bank account. If not completed, you will receive an annual payout.

Assignment of Pension Benefits Form

If you are in the Retiree Plan and would like to have your monthly premium deducted from a dedicated account, complete this form.

Post-Retirement Personal Care Account Form

Post-Retirement Care is designed to allow participants to use an account for qualifying premium expenses on a nontaxable basis after retirement.

PLAN DOCUMENTS & NOTICES


Summary Plan Description (SPD)

The SPD summarizes the key provisions of the Plan and includes important information about your benefits from the Plan.

Summary of Material Modifications #1 (SMM)

The Summary Plan Description is updated from time-to-time and therefore includes additional information and changes to the Plan in the form of a SMM.

Summary of Material Modifications #2 (SMM)
- No Surprises Act Preventive Care

The Summary Plan Description is updated from time-to-time and therefore includes additional information and changes to the Plan in the form of a SMM.

Summary of Material Modifications #3 (SMM)
- Reciprocity

The Summary Plan Description is updated from time-to-time and therefore includes additional information and changes to the Plan in the form of a SMM.

Summary of Material Modifications #4 (SMM)
- Out-Patient Drug Testing

The Summary Plan Description is updated from time-to-time and therefore includes additional information and changes to the Plan in the form of a SMM.

Summary of Material Modifications #5 (SMM)

The Summary Plan Description is updated from time-to-time and therefore includes additional information and changes to the Plan in the form of a SMM.

Summary of Material Modifications #6 (SMM)

The Summary Plan Description is updated from time-to-time and therefore includes additional information and changes to the Plan in the form of a SMM.

Summary of Material Modifications #7 (SMM)

The Summary Plan Description is updated from time-to-time and therefore includes additional information and changes to the Plan in the form of a SMM.

Summary of Material Modifications #8 (SMM)

The Summary Plan Description is updated from time-to-time and therefore includes additional information and changes to the Plan in the form of a SMM.

Summary of Benefits and Coverage

This document provides you with a quick reference to covered expenses, deductibles and out-of pocket costs. This is not a full explanation of the benefits covered by the Plan. For more information about the benefits covered by the Plan, see the Summary Plan Description.

Privacy Notice and WHCRA

This notice includes important information about protections for individuals who elect breast reconstruction in connection with a mastectomy as well. In addition, this notice informs you how you can request a copy of the Fund’s Privacy Notice. You will also receive this notice, annually, via US Mail.

Summary Annual Report

The Summary Annual Report provides insurance and basic financial information regarding the Plan and informs you of your rights to additional information.

Medicare Notice of Creditable Coverage

This notice contains information about your current prescription drug benefits and Medicare prescription drug coverage.

IMPORTANT NOTICE ABOUT FORM 1095B

This notice contains information regarding the 1095B Form.

Protections Against Surprise Medical Bills

This notice provides information regarding Protections Against Surprise Medical Bills.

FREQUENTLY ASKED QUESTIONS

Contact the Fund Office and ask to speak with an Eligibility Specialist. They will verify eligibility and request a new health & welfare ID card. Your new ID card will arrive within 7-12 business days from the date you notify the Fund Office that you need a new card. If you would like a temporary ID card emailed to you, please indicate such to the Eligibility Specialist.
Visit one of the health & welfare service providers, BlueCross BlueShield of Minnesota for medical providers and Prime Therapeutics for pharmacies. Once you have selected the desired provider site, you may login to your account and search for in-network providers.
If you would like to access your EOBs, please visit the BlueCross BlueShield of Minnesota website. Once you are on the BCBS website, you will need to login to your account to access your EOBs.
How to Read Your EOB thoroughly explains the layout of your EOB and how to easily read the information provided.
If you receive services from a non-participating provider you may have to submit the claim to the Plan. If you need to submit a claim, you will need to request an itemized bill and forward the bill to the Fund Office.
In order to change your mailing address, you must complete a Change of Address Form. You may print and complete the form, or you may contact the Fund Office and a form will be mailed to you.
To enroll your spouse for coverage under the Plan, submit a completed Family Update Form along with a copy of the marriage certificate to the Fund Office.

To enroll your dependent child for coverage under the Plan, submit a completed Family Update Form along with a copy of the birth certificate or adoption papers to the Fund Office.
Submit a completed Disability Claim Form to the Fund Office.
The Summary Plan Description is the document that contains the rules of the health plan and details the benefits available to you and your eligible dependents. The Summary of Benefits and Coverage provides basic information about the health plan such as the applicable co-pay amounts, deductible amounts, and out of pocket maximums.
You will receive your medical card 7-10 business days from the end of the month, following receipt of the required contributions to be eligible for benefits.
Yes, once you become eligible for benefits you will receive a separate ID card for your dental benefits. If you need to replace your card, contact the Fund Office.
You can review the Summary Plan Description electronically or you can call the Fund Office to request a hardcopy of the SPD Booklet.
You or your spouse must notify the Plan and mail a fully executed copy of your divorce decree to the Fund Office. Once the Plan receives the divorce decree, your former spouse’s coverage will be terminated the end of the month in which the date of your divorce is finalized.
If you meet certain criteria defined in the health & welfare Summary Plan Description you and your family may be eligible to participate for regular retiree plan or retiree Medicare supplement plan. Please contact the Fund Office for your retiree options for continuing health coverage.
If you have any questions about your eligibility, benefits or claims, contact the Fund Office at (218) 724-8883 or (877) 908-3863.

LIFE EVENTS

Birth or Adoption

To enroll your dependent child under the health plan, submit a completed Family Update Form. You must submit the completed enrollment form with the appropriate documentation to the Fund Office within 90 days of the event for Group I and Group II Employees. If you do not enroll your dependent in 90 days, claims will be denied until you submit the required information. Group III, IV, V and VI Employees (retirees) must enroll dependents within 30 days of the event and a dependent cannot be added afterwards.

Your natural child is eligible for coverage on the date of his or her birth. If you adopt a child, have a child placed with you for adoption, or acquire a stepchild through marriage, he or she will be eligible for coverage on the date of placement or marriage, as long as you are responsible for healthcare coverage and your child meets the Plan’s definition of a dependent child.

Marriage

When you marry, your spouse is eligible for healthcare coverage as of the date of your marriage. However, the Fund will not pay benefits on behalf of your spouse until you enroll your spouse for coverage. To enroll your spouse, send a copy of your certified marriage certificate to the Fund Office, as soon as it is available and complete a Family Update Form. Once your spouse is enrolled, benefits will be paid retroactively to the date of your marriage for Group I and II Employees if enrollment is completed within 90 day of marriage. For Group III, IV V and VI Employees (retirees), spouses may not be added after 30 days have passed from the time of the event.

Disability

If you are unable to work as a result of a non-work related injury or illness and you are under the care of a physician, you may be entitled to the weekly disability income benefit. To apply, submit a completed Disability Claim Form to the Fund Office. Once approved for the weekly disability benefit, you will be responsible to complete the Weekly Disability Supplementary Form.

Moving

If you have recently moved, please complete a Change of Address Form.

Loss of Employment/Coverage

If coverage is lost due to lack of sufficient employer contributions and hours in your individual record system (log in to view your Contribution History), then you will have the option to make self-payments or elect to continue coverage under COBRA for up to 18 months. Please contact the Fund Office with questions relating to your eligibility.

Divorce

If you and your spouse get a divorce or legal separation, your spouse will no longer be eligible for coverage. Your spouse may elect to continue coverage under COBRA for up to 36 months upon divorce or legal separation. You or your spouse must notify the Fund Office, within 60 days of the divorce or separation date for your spouse to obtain COBRA continuation coverage. You must also submit a copy of the divorce decree to the Fund Office.

Retirement

If you meet certain criteria defined in the health & welfare Summary Plan Description you and your family may be eligible to participate for regular retiree plan or retiree Medicare supplement plan. Please contact the Fund Office for your retiree options for continuing health coverage.

Death

In the event of your death, your dependents may continue coverage for up to 36 months by electing COBRA continuation coverage or by electing the retiree plan or the Medicare supplemental plan for surviving spouses and dependents. Your survivors will need to make the required self-contributions for this coverage.

SERVICE PROVIDERS

Doctor on Demand No Cost Virtual Visits
The Electrical Workers Fund covers Dr. On Demand visits at 100% with no out-of-pocket cost to you. Visit Dr. On Demand for a convenient online doctor visit:

  • • Urgent Care
  • • Behavioral Health
  • • Preventive Health
  • • Chronic Care

Blue Cross Blue Shield of MN
Visit Blue Cross/Blue Shield of MN to:

  • • Find an in-network provider
  • • Access Member Center to view your claims and EOBs (Explanation of Benefits)
  • • Find health and wellness information

Prime Therapeutics
Prime Therapeutics provides access to a retail pharmacy network, mail order prescriptions, and a specialty pharmacy for the treatment of complex conditions. Visit Prime Therapeutics to:

  • • Find an in-network provider
  • • Access your prescription history
  • • Search for medicines