Plan Description

I. Hospital Insurance

Financed by payroll taxes, and, if you are eligible to receive it based on your own–or your spouse’s–employment, you do not pay a premium. You will, however, have to make copayments under a schedule established by Medicare.

II. Medical Insurance

Partly financed by monthly premiums paid by those who enroll. Medicare sets the Part B premiums each year.

Eligibility Requirements

I. Medicare

Active and retired employees and their dependent spouses who are age 65 and over, who are totally and permanently disabled, or who have end-stage renal disease (kidney failure.)

II. Medicare Supplemental Plan

All persons for whom the Plan is permitted by law to be the secondary payer.

*For enrollment and eligibility information, call Social Security at 1-800-633-4227.

Claims Procedures

You may use the Plan’s claim form for any claim or you may use your provider’s own form. In order to speed up the processing of your claims, the Trustees suggest you use the following procedure when using the Plan’s forms:

  • Part I must be completed and signed by the member. If the claim resulted from an accident, please give complete information including the date, time and place.
  • The attending physician must either complete Part II of the Plan’s claim form or attach his own form or an itemized statement which contains an ICDA code. The Plan does not require a claim form completed by a lab technologist, radiologist, or consulting physician who assisted in or performed, a procedure which is billed by your attending physician.
  • A new claim form is required for each accident. If more than one family member has a claim related to an accident or other occurrences, a separate claim form is required for each family member.
  • Please identify all subsequent bills with your Local Union or your policy number.
  • An authorized representative may submit a claim on behalf of a claimant.
  • For a claim involving urgent care, a healthcare professional with knowledge of your medical condition may act as the authorized representative of the claimant.


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