Health and Welfare FAQs

• What is the difference between an HMO and the PPO Plan.

  An HMO is an organization that provides health care to a voluntarily enrolled group at a predetermined price. An HMO uses a group of doctors and other health care professionals also known as "network providers." The HMO services are prepaid and there is no annual deductible. Participants do share costs, however, by paying a fee called a co-payment at the time services are rendered.

  In the PPO Plan, contracting physicians and facilities are reimbursed based on contract amounts negotiated with Blue Shield. Non-contracting physicians and facilities are reimbursed based on usual, customary, and reasonable charges for covered services rendered. The trust is billed for the services and paid in accordance with the rules adopted by the Board of Trustees. The patient is then billed for any balances including deductibles and unpaid percentages.

• Are the Self-Funded PPO Plan benefits insured?

  No. All medical and mental health/substance abuse treatments are self funded benefits.

• I am a new participant. When do I first become eligible for benefits? When will I receive information about the Plan?

  You will become eligible on the first day of the second month following the date you accumulate 300 hours within a continuous twelve-month period. The EISB office will provide you with information concerning the Plan once hours are first reported on your behalf to the Plan.

• What documents do I need to provide to enroll in the Plan?

  You will be required to complete an enrollment card and provide copies of your birth certificate, marriage certificate or registration of domestic partnership, birth certificates of your dependents.

• Do I have to provide my Social Security Number?

  Generally yes in order to avoid confusion and disruption in coverage. However, the Plan Office will only use your number as necessary to ensure that the various providers properly credit your eligibility. As a part of EISB's security measures, all electronic information is encrypted and transmitted in a secure environment. Staff employees have been instructed to either shred or secure any documents that contain personal information in a locked drawer, including Social Security Numbers. If you participate in the Self-Funded PPO Plan, your physician only needs to use the last four digits of your number for identification purpose or your unique identification number that has been assigned and is displayed on your ID card.

• How many hours does it take to sustain eligibility once I become eligible?

  Beginning with work in November, 2006 for coverage in January, 2007, you need 120 hours. The hours can come from 1) contributions made on your behalf by a contributing employer or 2) from your hour bank reserve account. Eligibility is provided on a skipped month basis with hours worked in one month being applied to the second following month. For instance, January hours will apply to March coverage.

• If I become temporarily unemployed, how long will my residual hourbank reserves remain to my credit once I no longer have sufficient hours (less than 120 hours in my bank) to maintain eligibility?

  If you leave do not continue coverage either by making COBRA or self payment pursuant to the Temporary Disability Coverage provisions or you fail to achieve the 300 hours to qualify for initial coverage, you will lose any credit in your reserve bank once you have had no hours credited to your bank for a period of twelve consecutive months.

• What is an hour bank reserve? How is my hour bank credited and what is the maximum number of hours?

  The reserve account system includes a separate record for each active member and includes hours that were not already used to provide eligibility, up to a maximum of 1,000 hours. For instance, if you work 130 hours in November, 2006 or later, 120 hours will be used to provide eligibility and the remaining 10 hours will be added to your hour bank reserve account.

• What happens to the contributions that are made in excess of the 1,000 hour maximum?

  The contributions on hours in excess of the maximum are not credited to individuals but remain in the pooled assets that are used to offset the costs of providing benefits and administration of the Plan.

• What if the combination of hours worked and the hours in my hour bank are not sufficient to provide me eligibility? Can I make up the difference?

  If you do not have sufficient hours, you must pay the full direct or COBRA payment required under the Plan. You may not make up the difference. The only exception to this rule is that day school apprentices who are in good standing and whose loss of eligibility is solely attributed to attending day school may make up the difference.

• How will I know when my hour bank reserve will run out?

  You may call the Plan Office at any time you wish to ask how many hours you have in your hourbank. You will receive a notice shortly before your hour bank reserve account runs out regarding your COBRA (self payment) Continuation rights. You may also access information regarding your hours and hour bank balance by registering on EISB's interactive website. For more information, contact the Plan Office at 415-263-3670.

• What is the hourly contribution rate my employer is required to pay the Plan on my behalf?

  Your employer is required to pay the rate set forth in the collective bargaining agreement. Effective with June 1, 2012 hours, the rate is $12.38 per hour for employees working under the Inside Wire Agreement. Of the Total contribution, $12.15 is allocated to the Health Plan providing medical, dental and vision benefits, and $0.23 is allocated to the Long Term Disability Plan.

• May I freeze my hour bank and elect to be covered at a future date?

  No, this is would lead to selection against the Plan by allowing individuals to use their hour banks only when they need the coverage.

• What is the San Francisco Electrical Workers Health & Welfare Trust Fund?

  It is a multiemployer welfare benefit plan that is jointly managed by union representatives and representatives of the employers. The trust, rather than each participating employer, provides and manages your group health care and certain other welfare benefits. Each employer contributes on a cents-per-hour basis the amount specified in the collective bargaining agreements on behalf of each of their "covered employees." These contributions are held in the Plan's trust for the purpose of providing health care and other benefits to plan participants and their eligible dependents.

• Who are the Trustees of the Plan and what are their functions?

  The Plan's Board of Trustees consist of three trustees selected by IBEW Local 6 and three trustees selected by the San Francisco Electrical Contractors Association, with each entity also selecting an alternate trustee who attends all meetings but takes action only when a regular Trustee is not available. Your Trustees invest the Plan's assets, interpret and amend the Plan, decide policy questions, and contract with various advisers who render advice and/or perform services for the administration of the Plan. This includes an accountant, legal counsel, an investment manager, plan manager and plan consultants.

• What plans are available to me and how do I know which one will be best for my family?

  The trust provides a self-funded PPO plan, and two HMO options--- Kaiser and Blue Shield. Some families prefer the convenience of the HMO arrangement because the co-payments are made at the time of treatment and there are no subsequent billings to worry about. Others prefer the more traditional Self-Funded PPO Plan arrangement because they are not limited to an established network of doctors or facilities and are not confined to treatment within any designated service area or facility.