Health and Welfare – General FAQs

Where do I mail in my claims?

If you are an active member and using BlueCrossBlueShield PPO network providers, the providers will submit claims for you and there is nothing you need to do. All other claims, including all Medicare and dental claims, should be mailed directly to the Fund Office. If you have received a second notice from your provider of service, please contact the Fund Office.

How do I find a network doctor or hospital? How do I know if my doctor or hospital is in the network?

Contact your network at the number listed below:

  • Medical providers in Illinois, contact BlueCross BlueShield of Illinois at 800.571.1043 or
  • Medical providers outside of Illinois, contact Blue Card at 800.810.BLUE or
  • Dental providers, contact Delta Dental of Illinois at 800.323.1743 or

What is a deductible?

Each year, before the Plan begins to pay for most covered expenses, you or your family pay the first dollars of eligible expenses. This is the deductible, which is stated per person, with a family maximum. The deductible is payable to the doctor or hospital where the charges were incurred. The Explanation of Benefits (EOB) you receive on the charges you submit will show the amount you owe.

What is a copay and who do I pay it to?

After satisfying the deductible, you and the Plan share responsibility for eligible medical expenses; this is known as copayment. For Plan A, the Plan pays 90% for PPO network expenses or 80% for non-PPO network expenses. You pay the remaining 10% for PPO network or 20% for non-PPO network expenses, which are within the Fund’s reasonable and customary guidelines, to the doctor or hospital where the services were performed.

What is the difference between network and non-network?

A Preferred Provider Organization (PPO) is a network of providers (known as in-network providers) that have been contracted to provide services at discounted rates. The discounted rates and the associated savings are the biggest difference between in-network and out-of-network providers. The Fund shares any network savings with you by reducing the amount that you owe for the services performed by in-network providers. In addition, for out-of-network providers, you are responsbile for paying any amounts over the Plan’s reasonable and customary guidelines.

Are my benefits limited?

Once your payments toward the deductible and co-payments for eligible medical charges reach the annual out-of-pocket maximum, the Plan will usually pay 100% of most eligible expenses for the rest of the Plan Year. Expenses not covered under the Plan do not apply toward the out-of-pocket maximum. In addition, some expenses are never paid at 100%.  It is extremely important for you to understand the medical plan that you are covered under.  Please refer to your Summary Plan Description and Benefit Summary for details.

What is a dental pre-determination and why do I need one?

The Fund Office recommends that you get a dental pre-determination whenever you are having dental work in excess of $250. This will give you an estimate of what the Fund will consider for payment and will help you know in advance just how much you will owe your dentist. This is an estimate of benefits and not a guarantee of coverage.

What do I need to do if I have a mental health or substance abuse issue?

You must contact the Plan’s confidential provider, Employee Resource Systems, Inc. at 888.374.1674. They will walk you through the process and refer you to an appropriate provider of service. Everything discussed in this phone conversation is kept highly confidential between you and the Master level clinician that you speak with regarding your situation.

How do I qualify for the retiree coverage under the Retiree Health and Welfare Plan?

To be eligible for retiree coverage, you must:

  • Be eligible for Health and Welfare Plan coverage under the active plan on your retirement date;
  • Have at least 10 Vesting Service Years in the Pension Plan;
  • Have at least 40 quarters of eligibility in under the Health and Welfare Plan;
  • You must have active employee contributions not in excess of 12 months from the time you leave Covered Employment to your retirement effective date.
  • PLEASE NOTE:  There are special rules if you are considered permanently disabled or you are a Municipality Employee.

Please contact the Pension Department if you have specific questions pertaining to your eligibility under the Retiree Welfare Plan.

Are payments required for retiree coverage under the Retiree Welfare Plan?

Yes. Payment is required before the first month of your retirement. However, if you have a bank of hours to run out for active coverage on your retirement date, payments will begin when you no longer have sufficient hours for active coverage.  Premiums for the Retiree Welfare Plan are subject to change each July 1. You will receive information from the Fund Office prior to the monthly premium rate change.

Are retiree benefits under the Retiree Welfare Plan the same as for active participants?

When you become eligible for retiree coverage, you are no longer eligible for weekly disability, death (you may qualify for the post-retirement death benefit of $10,000 from the Pension Plan), or accidental dismemberment benefits. Also, under retiree coverage there is a Maximum Annual Benefit for prescriptions of $30,000 per Calendar Year per eligible dependent.

If I marry or re-marry after retiring, can I add my new spouse to my retiree coverage under the Retiree Welfare Plan?

Yes, but you must submit a copy of your marriage certificate and request a new application for coverage within six months of your marriage date. Coverage will not begin until a payment is made for dependent coverage.

What happens when I become eligible for Medicare?

Your payment for retiree coverage under the Retiree Welfare Plan will be reduced as Medicare will be your primary coverage and the Fund will be secondary. You must submit a copy of your Medicare card to the Fund Office. For more information, contact Member Services at 708.579.6600.



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