Welfare FAQ’s – Frequently Asked Questions

Q.   Are routine physicals covered under my plan?

A.   As a grandfathered health plan under the Patient Protection and Affordable Care Act, the plan is not required to include the provision for preventive health services without any cost sharing. However, the plans do cover some preventive care services. Please refer to your Summary Plan Description for a list of those services and the specific coverage.

Q.   I had my last routine mammogram on March 8 of last year. Can I have my next routine mammogram on March 5 or do I need to wait until after March 8? How is my routine mammogram covered under my plan?

A.   The Core plans allow for one routine mammogram each calendar year and the D9A plan allows for one routine mammogram between ages 35-39 and then each calendar year thereafter. Once per calendar year means that you could have one in December of one year and then again in February of the next. The eligible charge is subject to your deductible and then reimbursed at the appropriate co-insurance.

Q.   How do I find a network provider?

A.   A network provider will give you the best benefit for your dollar. To locate a contracted provider follow these steps Locating a Network Provider

You can also contact the Welfare Fund office at any time.

Q.   Does my plan cover routine immunizations and if so, how are they covered?

A.   The plans allow for routine childhood immunizations from birth through age 18 only. The plans reimburse the eligible charges at 100% of the allowed amount. Refer to your Summary Plan Description for the list of the routine immunizations.

Q.   Does my out- patient surgery require pre-certification?

A.   Only select out-patient surgeries require pre-certification with Meritain. Please refer to the Pre-Certification List on the homepage of this website.

Q.   My physician has prescribed diabetic supplies are they covered under my plan? I tried to get them at the pharmacy and was told they are not covered.

A.   Diabetic supplies are covered under the major medical portion of your plan, not under your pharmacy benefits. The charges would be subject to your deductible and then reimbursed at the appropriate co-insurance. Using a network provider will give you the best benefit. Contact the Welfare Fund Office for more.

Q.   What laboratory can I use?

A.   Eligible members have the freedom of choice to use any laboratory. However, we are seeing an increase in the number of out-of-network laboratories and this translates into larger out of pocket for our members. To get the best benefit under the plan, you should use a network lab. Be sure to let your physician know that they should use a contracted lab for all testing.