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Frequently Asked Questions

Click on the links below to view the questions for each plan. If your question is not answered, contact the appropriate department using the numbers listed on the “Contact the Joint Board” page.

General Questions

What do I need to do to change my home address?

If you move, you must let the Members’ Records Department know your new address. This must be done in writing. Simply complete the Change of Address form (PDF, 29K) and mail it to the Members’ Records Department.

How do I add my spouse and children to my benefits?

In order to add a spouse or child to your benefits you must complete the enrollment form found on the Forms & Documents page and return it to the Members’ Records Department. If you are adding a spouse, you must provide a copy of your marriage certificate. If you are adding a child, you must provide the child’s birth certificate indicating the participant’s name.

My child is now over age 19 but is a full-time college student. How do I make sure dental coverage does not lapse?

Once a dependent child reaches the age of 19, coverage is terminated under the Dental Benefit Plan of the Electrical Industry and the Dental Benefit Plan of the Elevator Industry, as applicable. However, if the child is a full-time student, coverage may be extended up until the child reaches age 26 (25 for Elevator Division) if proof of full-time college enrollment is provided every semester. Proof of enrollment generally means an original letter from the college registrar’s office.

Is it important to keep my beneficiary information current?

Yes, it is very important, especially if you are married. For example, if you are single and name a beneficiary and subsequently marry without changing the beneficiary, your spouse and the named beneficiary will divide all benefits equally. The same situation would apply to a divorced participant who remarries without changing the beneficiary from the former spouse to the new spouse.

How do I update my beneficiary form?

Click here to access a Beneficiary Designation Form (PDF, 20K). Click here for more beneficiary information Important Beneficiary Information (PDF, 70K). You will note that there are specific requirements to be fulfilled if you designate a beneficiary other than your spouse.

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Deferred Salary Plan (“401(k) Plan”)

How can I find out my 401(k) account balance?

You may contact Mercer at 1-877-JIB-401K (1-877-542-4015) 24 hours a day, 7 days a week to obtain account balance information, to change investment funds, or to request a distribution or loan. Remember to have your PIN number available when you call. You may also obtain your account balance online at www.ibenefitcenter.mercerhrs.com.

Is there a maximum amount that an employee can contribute to the 401(k) Plan during the taxable year?

Yes, and it varies by year in accordance with IRS regulations. However, if you are fifty years or older, you are eligible to contribute additional “catch-up” amounts up to the maximum contribution. Remember: These amounts do not include any contributions your employer may be required to make.

When am I eligible for benefits under the 401(k) plan?

You may receive your own full account balance when one of the following occurs:

In addition to the events listed above, you may also receive a distribution from your Employer Contribution Account for any one of the following:

The new benefits are available to participants based on classification and applicable Collective Bargaining Agreement.

The benefits described above will be subject to a 10% IRS penalty if under age 59½.

Where can I get distribution, loan and hardship withdrawal forms?

For all applicable forms, go to Mercer online: https://ibenefitcenter.mercerhrs.com.

Am I required to exhaust my Additional Security Benefits Plan account, VHUP account, and/or HRA account before I access my Deferred Salary Plan employer Account for the reimbursements allowed under this Plan?

Yes. Please click here (PDF, 11K) for further details.

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Additional Security Benefits Plan

What happens to my Additional Security Benefits Plan account when I retire or leave the industry?

Upon your retirement or withdrawal from the industry, you may apply for weekly Supplemental Unemployment Benefits until your account balance is exhausted.

Under what circumstances may I receive benefits from the Additional Security Benefits Plan?

The Plan allows a participant to receive the following benefits, subject to the submission of proper documentation as described in the Additional Security Benefits Plan (PDF, 410K):

How do I apply for benefits under the Additional Security Benefits Plan?

Simply complete the Application for Benefits Form (PDF, 107K) and attach the requested documentation.

What happens to my Additional Security Benefits Plan account when I retire or leave the industry?

Upon your retirement or withdrawal from the industry, you may apply for weekly Supplemental Unemployment Benefits until your account balance is exhausted.

When did employer contributions stop coming into the Additional Security Benefits Plan?

For most participants, contributions ceased as of January 1, 2005. However, some participants continued to receive contributions through February 28, 2005.

How do I determine whether the Additional Security Benefits Plan or the VHUP is the primary plan for supplementary unemployment, vacation, and/or holiday benefits?

To determine which plan is the primary plan for any of these benefts, click here (PDF, 11K).

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Annuity Plan

May I receive benefits from the Annuity Plan prior to retirement, withdrawal from the industry or total disability?

No. You can only receive payment of Annuity benefits from the Plan upon retirement, total withdrawal from the industry or total disability.

How are benefits paid under the Annuity Plan?

Effective August 1, 2007, monthly benefits up to $2,500 are paid from account balances greater than $5,000 at the time of application. Account balances less than $5,000 at the time of application are paid in a single lump-sum. While balances less than $1,000 are paid automatically, you must apply for your distribution if the balance is greater than that amount. In addition, if your account balance is over $20,000, the Plan allows for a one-time lump sum distribution of up to $20,000.

May I choose the date when I wish to receive Annuity Plan benefits due to retirement or withdrawal from the industry?

You may elect to receive monthly payments at any time between your retirement or withdrawal from the industry and the April 1st following the date you reach age 70½. Federal law requires that the Plan commence payments automatically as of the April 1st following the date you reach age 70½ or your retirement, whichever is later.

Upon my death, what Annuity Plan benefits are payable to my beneficiary?

Your named beneficiary is entitled to receive monthly distributions of any remaining account balance. In addition, the Annuity Plan pays a maximum death benefit of up to $45,000 to the named beneficiary, which will first be distributed in monthly installments of up to $2,500. The amount is based on your age and years of service. A one-time lump-sum payment, equal to the greater of 25% of the total initial account balance plan plus the death benefit or $20,000, is also available.

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Dental Plan

What are the differences between the Dental Fee-For-Service, HMO and PPO Programs?

The fee-for-service plan allows you to go to any dentist of your choice. You or your dentist must then submit a claim form to Blue Cross for reimbursement. The Plan will pay according to its established fee schedule. The difference between the amount the provider bills and the amount the Plan pays is your responsibility.

For a Dental Plan claim form click here. Note: It is very important that you complete the correct form for the Plan you are in, as failure to do so will delay the processing of your claim and reimbursement, if applicable.

The Blue Cross Dental Managed Network Program, which is an HMO, requires you to enroll in the program and remain enrolled for a minimum of one year. Once you are enrolled, you may choose your dentist from a panel of participating dentists and then must use only that dentist for you and your family, if applicable. Covered services will be paid in full, and you will not have any out-of-pocket expense. If you use a dentist outside of the program, you will not be covered for those services.

To enroll in the Blue Cross Dental Managed Network Program, contact the Members’ Records Department at 718-591-2000, ext. 2491.

The DDS, Inc. program allows you to enroll at any time during the year by calling DDS, Inc. at 1-800-255-5681. The DDS, Inc. network is a closed panel of participating dentists who agree to accept the Plan’s allowances for covered services as payment in full. Once you have selected your DDS provider, you may make an appointment. No claim forms are required.

How do I file a dental claim?

Participants in the Empire Blue Cross and Blue Shield Fee-For-Service Program (the “Fee-for-service Program”): You and your dentist will need to complete a Dental Claim Form for all services received. You may obtain a Dental Claim Form by either clicking here or by contacting the Members’ Records Department. You complete the patient’s portion of the Dental Claim Form and your dentist completes the remainder of the form. Then return the completed form to Empire Blue Cross and Blue Shield Dental Benefits Program, P.O. Box 791, Minneapolis, MN 55440-0791.

Participants in the Empire Blue Cross and Blue Shield Dental Managed Network Program (the “Managed Network Program”): Once you enroll and select a dental office, you will not need to submit any forms or obtain pre-certification for any services. Your dental office will take care of any required paperwork.

Participants in the DDS, Inc. Program: You will not need to submit any forms or obtain pre-certification for any services. The DDS dental office is responsible for any required paperwork.

How long do I have to file a dental claim?

You are required to submit a Dental Claim Form within one year of receiving dental services. Although not required, you are encouraged to contact Blue Cross Blue Shield in advance of receiving dental services to verify that coverage is available, especially in the case of prosthetic and orthodontic services.

How much do the Dental Plans allow for orthodontics?

The maximum amount payable is $4,000.00 per lifetime per person. Effective Otober 1, 2013, interceptive orthodontics are covered up to $700 and are included in the $4,000 lifetime maximum.

How much does the Dental Plan allow for prosthetics (crowns and bridges)?

The maximum amount payable is $4,000.00 per person per calendar year.

How many cleanings per year do the Dental Plans cover?

Both Dental Plans cover two cleanings per year (once every 6 months).

Are dental implants covered?

For all participants in the Dental Benefit Plan of the Electrical Industry, non-cosmetic dental implants will be covered for charges up to $900 (effective October 1, 2013). Associated charges for abutments and bone grafts will also be covered as per the Plan's fee schedule.This benefit is part of the $4,000 annual prosthetic maximum and is part of the fee-for-service program only. Participants in the DDS preferred provider organization and the Empire Dental Managed Network Program are subject to the fee-for-service plan allowances for this benefit only.This applies to all services rendered on or after August 1, 2007.

Since implant related services are reimbursed according to the Plan's fee schedule, it is strongly recommended that your dentist submit a pre-estimate request on your behalf to either Blue Cross or DDS, Inc. This will help estimate your out-of-pocket costs.

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E.E.S.I.S.P.

How do I file a Workers’ Compensation claim for a job related accident?

Immediately after the accident, report it to your foreman or supervisor who will then file a 24 Hour Report and ADR C2 with E.E.S.I.S.P. You will then receive a post card from E.E.S.I.S.P. giving you a case number. If you do not receive this post card, contact your employer to make sure the accident report was filed.

Please note, medical bills or payment for lost time will be delayed or not paid without an accident report

If I need medical treatment for my ADR claim, who should I contact?

Contact MagnaComp at 1-888-336-8773 and they will recommend doctors in your area. Please note, you must use a doctor in the MagnaComp network or payment of bills will be denied.

If you require immediate or emergency treatment following an injury, you may go to any hospital or walk-in clinic. If additional treatment is required, you must contact MagnaComp for a referral to an in-network provider.

When will I receive my first Workers’ Compensation check?

If all forms have been filed correctly, you should receive your first check approximately 12-14 days after your first full day out of work.

How much is the Workers’ Compensation benefit?

The statutory portion of the benefit is two-thirds of your average weekly wage for the year prior to the date of your accident with a maximum of $400 per week. Under most circumstances, you will also be entitled to a collectively bargained supplementary benefit up to a maximum of $155 per week. The supplementary benefit is subject to different criteria than the statutory benefit.

Can my Workers’ Compensation or Disability checks be electronically deposited into my checking or savings account?

No, payment is only made by check.

What does the inactive letter that I received mean?

The inactive letter tells you that you are currently not losing time from work and that you are not under treatment for that claim. The claim has been closed, but if further treatment is needed, contact E.E.S.I.S.P. for information on how to reopen the claim.

How do I file a Disability claim?

To file a disability claim, for a non-work-related illness or injury, contact E.E.S.I.S.P. at 718-591-2800 for a telephone interview. You must file either a DB-450 form or a DB-300 form, depending on your employment status.

The DB-300 (PDF, 59K) is only used when you become disabled and have been on unemployment for four weeks or more. This form is sent to:

    Workers’ Compensation Board
    Disability Benefits Bureau
    100 Broadway – Menands
    Albany NY 12241
    1-800-353-3092

You should complete the front of the appropriate form and your doctor will complete the back of the form.

The DB-450 (PDF, 65K) is used when you become disabled due to a non-work-related illness or injury while employed or if you become disabled prior to four weeks of unemployment. This form is sent to:

    E.E.S.I.S.P.
    158-11 Harry Van
    Arsdale Jr. Avenue
    Flushing, NY 11365.

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Educational and Cultural Trust Fund

How long do I need to work for a contributing employer before I am eligible for Educational and Cultural Trust Fund benefits?

In order to register for the Educational and Cultural Trust Fund classes, or enroll your children in Camp Integrity, you must be employed for at least six months by an employer(s) who contributes to the Fund on your behalf. This would include the Citizenship Responsibility course, which prepares you to serve Jury Duty, and enables you to receive the Jury Duty Benefit for any days you serve as a juror.

To be eligible for the Tuition Reimbursement Benefit, you must be employed by a contributing employer for at least three years prior to the start of the semester you submit an application for reimbursement.

College Tuition Loans are available if you are employed by a contributing employer for at least five years immediately prior to your application.

To submit an application for the Scholarship Award Program, you must be employed by a contributing employer for at least five years immediately prior to application; or a retired participant who meets the eligibility requirements.

As an eligible participant of the Educational and Cultural Trust Fund, can I pursue a certification program in a field related to the industry?

As a rule, members and spouses are eligible to receive up to a lifetime maximum of $20,000 Tuition Reimbursement for any courses successfully completed while matriculated at an accredited college. You will be reimbursed for any credits earned, which will be applied towards an Associates, Baccalaureate, Masters, Ph.D., M.D. or Jurist Doctorate Degree. However, you may apply for Technical Training Courses as long as these courses are job-related and will be used to enhance your skills for work within the industry.

To be considered for reimbursement for Technical Training Courses, you must submit the proper E&C Trust Fund forms for Technical Training to establish pre-approval before taking the Technical Training Course. Each application form to apply for reimbursement for a Technical Training Course must be completed by the member’s employer.

I have completed my Baccalaureate Degree and was reimbursed through the Educational and Cultural Trust Fund. Now I would like to receive reimbursement for a second Baccalaureate Degree in another major. Will the Fund reimburse me for these courses?

No. When a participant or a spouse completes their B.A. degree, the Fund will reimburse courses leading to the next degree level, so that the student must pursue a Masters Degree.

I borrowed through the College Tuition Loan program for last semester, and I am currently unemployed. My loan has become delinquent. Can I resume weekly deductions when I return to work? Will I be able to borrow for this coming semester?

In the event an employer fails to deduct for a given week, the borrower shall make that payment directly to the Fund. In cases where you are not employed, the maximum allowable grace period is 30 days. After this 30-day period, you are required to make monthly payments for any weeks not submitted through your employer’s payroll deductions. Subsequent loans will not be approved as long as you are in default and remain delinquent on the current loans.

My grandchild (nephew, niece) would like to submit an application for the Scholarship Program.

The applicant must be an eligible dependent, or a legally adopted child of a participating member of Local Union #3, I.B.E.W.

I am retired from the industry. Am I still eligible for E&C benefits?

Since the inception of the Joint Industry Board in March 30, 1943, funding for benefits has been through labor-management cooperation. The E&C benefits program is solely funded through contributions made by contributing employers to the E&C Fund on their employees’ behalf. When a participant retires from the industry, contributions on the member’s behalf and the participant’s eligibility cease, with the exception of the E&C Scholarship Program. Realizing that some retired members have College-bound dependents, the E&C Fund has extended the Scholarship Program to allow the eligible dependents of pension members, who otherwise meet the eligibility requirements, to enter the competition for a four-year Scholarship.

I work for a non-contributing employer. Am I eligible for E&C benefits?

No. The E&C benefits program is solely funded by employer contributions under the Local Union #3, I.B.E.W. Collective Bargaining Agreement with employer members of the New York Electrical Contractors Association and the Association of the New York Electrical Contractors. Ask your Local Union #3, I.B.E.W. employee representative, or shop steward for further information regarding your benefits.

I am on workers’ compensation. May I apply for educational benefits from the Fund?

To be eligible for E&C benefits, you must be employed or be available for employment. If you are receiving workers’ compensation, the E&C classes are not available to you until your employment is resumed, or you become available for full employment.

However, the Tuition Reimbursement, Scholarship and Loan Program benefits are extended for a period of two years while you are on workers’ compensation. Should you remain on disability after the two-year period, E&C benefits cease until you return to full employment within the industry for a period of six months to one year depending on the amount of time you remained disabled. All requests for benefits go before a committee for eligibility approval.

I am currently working on a job that requires a respirator, how quickly can I be fit-tested to use a respirator?

In order to be fit-tested, you must first complete training in the use of Respiratory Protection Equipment. You will be assigned to a class based on a class pending list. When notified to take a class, you are required to complete a medical surveillance program, which includes a physical examination including a chest x-ray and a pulmonary function test. You are not permitted to take any course that requires the use of a Respirator and fit-testing without a Medical Surveillance Affidavit (M-91) form authorized by an examining physician of the J.I.B. Medical Department, or your personal licensed physician.

How much would I need to pay to take an OSHA certificate training class?

The Educational and Cultural Trust Fund offers a wide variety of OSHA classes to members free-of-charge. In classes involving licensing fees, such as the Asbestos Restricted Handler and the Asbestos Handler classes, all fees are paid by the Educational and Cultural Trust Fund to the D.O.H., D.O.L., and the D.E.P. Classes are conducted evenings at the Electric Industry Center in Flushing, Queens. Most classes require an annual refresher course.

If I do not take my annual refresher course and my license or certification expires, would I be able to be rescheduled for a refresher course at a later date?

In the case of the Asbestos Restricted Handler or the Asbestos Handler Certification Class, when your state license has expired, the D.O.H. and D.O.L. requires that you take an initial class to renew your license. Since additional fees are required for this initial class, you are required to pay a penalty of $98.50 in order to renew your state and city licenses. The respiratory and lead courses also require an annual refresher. OSHA regulations require that if you complete the Confined Space Initial Course, you must take a refresher course every two years. The confined space, initial course, and the respitory and lead courses are offered at no charge

I am an apprentice working on a job-site that requires OSHA training, are the OSHA classes available to me?

The Educational and Cultural Trust Fund offers classes to all eligible participants; however, apprentices should complete their apprenticeship training before requesting OSHA classes given by the Educational and Cultural Trust Fund.

My employer sent me to an outside agency to obtain an asbestos license; may I now take my refresher course through the Educational and Cultural Trust Fund?

When you submit the proper proof of certification by the N.Y.S. Department of Labor and the N.Y.C. Department of Environmental Protection, you will be put on a pending list for the refresher course. You must meet the eligibility requirements in order to register for any E&C Fund courses, and must submit the required Medical Surveillance Affidavit (M-91) form authorized by an examining physician of the J.I.B. Medical Department, or the member’s personal licensed physician prior to taking any OSHA classes requiring the use of Respiratory Protection equipment.

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Elevator Division Dental Plan

What are the differences between the Dental Fee-For-Service, HMO and PPO Programs?

The fee-for-service plan allows you to go to any dentist of your choice. You or your dentist must then submit a claim form to Blue Cross for reimbursement. The Plan will pay according to its established fee schedule. The difference between the amount the provider bills and the amount the Plan pays is your responsibility.

For a Dental Plan claim form click here. Note: It is very important that you complete the correct form for the Plan you are in, as failure to do so will delay the processing of your claim and reimbursement, if applicable.

The Blue Cross Dental Managed Network Program, which is an HMO, requires you to enroll in the program and remain enrolled for a minimum of one year. Once you are enrolled, you may choose your dentist from a panel of participating dentists and then must use only that dentist for you and your family, if applicable. Covered services will be paid in full, and you will not have any out-of-pocket expense. If you use a dentist outside of the program, you will not be covered for those services.

To enroll in the Blue Cross Dental Managed Network Program, contact the Members’ Records Department at 718-591-2000, ext. 2491.

The DDS, Inc. program allows you to enroll at any time during the year by calling DDS, Inc. at 1-800-255-5681. The DDS, Inc. network is a closed panel of participating dentists who agree to accept the Plan’s allowances for covered services as payment in full. Once you have selected your DDS provider, you may make an appointment. No claim forms are required.

How do I file a dental claim?

Participants in the Empire Blue Cross and Blue Shield Fee-For-Service Program (the “Fee-for-service Program”): You and your dentist will need to complete a Dental Claim Form for all services received. You may obtain a Dental Claim Form by either clicking here or by contacting the Members’ Records Department. You complete the patient’s portion of the Dental Claim Form and your dentist completes the remainder of the form. Then return the completed form to Empire Blue Cross and Blue Shield Dental Benefits Program, P.O. Box 791, Minneapolis, MN 55440-0791.

Participants in the Empire Blue Cross and Blue Shield Dental Managed Network Program (the “Managed Network Program”): Once you enroll and select a dental office, you will not need to submit any forms or obtain pre-certification for any services. Your dental office will take care of any required paperwork.

Participants in the DDS, Inc. Program: You will not need to submit any forms or obtain pre-certification for any services. The DDS dental office is responsible for any required paperwork.

How long do I have to file a dental claim?

You are required to submit a Dental Claim Form within one year of receiving dental services. Although not required, you are encouraged to contact Blue Cross Blue Shield in advance of receiving dental services to verify that coverage is available, especially in the case of prosthetic and orthodontic services.

How much do the Dental Plans allow for orthodontics?

The maximum amount payable is $4,000.00 per lifetime per person. Effective October 1, 2013, interceptive orthodontics are covered up to $700 and are included in the $4,000 lifetime maxium.

How much does the Elevator Dental Plan allow for prosthetics (crowns and bridges)?

Effective March 1, 2011, the maximum amount payable is $4,000.00 per person per calendar year.

How many cleanings per year do the Dental Plans cover?

Both Dental Plans cover two cleanings per year (once every 6 months).

Are dental implants covered?

For all participants in the Dental Benefit Plan of the Elevator Industry, non-cosmetic dental implants will be covered for charges up to $900 (Effective October 1, 2013). Associated charges for abutments and bone grafts will also be covered as per the Plan's fee schedule.This benefit is part of the $4,000 annual prosthetic maximum and is part of the fee-for-service program only. Participants in the DDS preferred provider organization and the Empire Dental Managed Network Program are subject to the fee-for-service plan allowances for this benefit only.This applies to all services rendered on or after March 1, 2011.

Since implant related services are reimbursed according to the Plan's fee schedule, it is strongly recommended that your dentist submit a pre-estimate request on your behalf to either Blue Cross or DDS, Inc. This will help estimate your out-of-pocket costs.

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Employees Security Fund Medical, Prescription Drug and Dental Plan (for members of the Fixture, Manufacturing, or Supply Divisions)

What is my annual family prescription drug maximum?

Effective January 1, 2012, your annual family maximum for prescription drugs is $4,875. (ESF Medical Health & Welfare Plan)

How do I know how much my prescription drug co-pay will be?

Your co-pay is based on the status of your drug and the quantity (number of days supply) you receive. Your co-pays are shown on the ESF Medical plan page.

You can minimize your out-of-pocket expense by speaking with your physician about prescribing a generic or Plan preferred formulary drug for you whenever possible. You can find information about generic drugs and pricing details online at www.medco.com or by calling Medco Member Services at 1-800-413-7402.

I don’t understand the difference between generic, Plan-preferred brand-name and non-preferred brand-name drugs.

Generic drugs are manufactured after the original manufacturer’s patent expires. These drugs are safe, effective and FDA-approved to meet the same rigorous standards for quality, strength and purity as their brand-name counterparts. They are less expensive because the generic manufacturer does not have the investment costs of the developer of a new drug.

Plan-preferred brand-name drugs are those that do not yet have a generic equivalent available and are preferred based on safety, effectiveness and cost. An independent Medco committee of physicians and pharmacists determines which brand-name drugs are preferred. They are included on a drug list know as a formulary.

Non-preferred brand-name drugs are those that do not yet have a generic equivalent, but for reasons of effectiveness or cost, are not on your Plan’s formulary drug list.

Do I need to pre-certify in order to receive prescription drug benefits?

In order to qualify for coverage, certain medications require pre-certification in order to determine the appropriateness of the drug in treating your condition. If you file your prescription through Medco, their pharmacist will initiate the pre-certification review with your doctor. If you visit a retail drugstore, your pharmacist will let you know if your medication requires pre-certification. If so, your doctor must call a special toll-free number at Medco to initiate a review. This process typically takes one or two business days. Once the review is complete, Medco will notify you and your doctor of the decision. If the review is approved, you will receive a letter indicating the length of approved coverage. If the review is denied, the letter will include the reason for denial and instructions on how to submit an appeal if you choose.

What drugs are not covered under the ESF Medical Health and Welfare Plan Prescription Drug Plan?

The Plan does not cover weight-loss medications (such as Xenical® and Meridia®), erectile dysfunction medications (such as Cialis®, Levitra®, and Viagra®), fertility medications (such as Clomid® and Repronex®), non-sedating antihistamines (such as Allegra®, Clarinex®, and Zyrtec®) and vitamins. If one of these medications is medically necessary, you may call the Joint Industry Board Members’ Records Department at 1-718-969-4030 to obtain a form for you and your doctor to complete and submit to the PHBP Medical Plan for medical review.

Do I need to use the Medco by Mail service?

Yes. Once you have filled two prescriptions of the same drug at your pharmacy, you must then use the Medco by Mail service for your prescriptions. Failure to do so will result in your prescription being denied at the pharmacy.

Does the list of maintenance medications ever change?

Yes. The list of maintenance drugs is monitored by Medco and changed periodically. For example, GI drugs (such as Nexium, Protonix, omeprazole) have been added to this list. Insulin is no longer on the list. Medco will now advise you when your medication either goes on or comes off of the maintenance drug list. Once a drug comes off the list, you may purchase it at your retail pharmacy. Prescriptions for maintenance medications must be mailed to Medco after the first fill and one refill.

My doctor requires that I take a drug that is NOT Plan-preferred and for which there are no equivalent preferred brands or generics. Do I still have to pay the highest co-pay?

If this occurs, you can call the Joint Industry Board Members Records Department at 1-718-591-2000, ext. 2491 to obtain a form to initiate a review to determine if the preferred brand co-pay applies.

Where can I go for a vision exam and what services are covered under the ESF Medical Health & Welfare Plan?

The vision benefit entitles you, your legal spouse and eligible children to an eye examination once each year by an optometrist or an ophthalmologist and, if prescribed, one pair of eyeglasses each year. You may receive vision care services in the following ways:

What is the annual diagnostic benefit? (ESF Medical Health & Welfare Plan)

This benefit enables you, your legal spouse and eligible children to obtain, once each year, a physical examination for diagnostic purposes only. The Diagnostic Medical Benefit provided by the Plan is available in the following ways:

Retirees who are eligible for Medicare must submit their charges to MagnaCare before submitting them to Medicare for payment.

How do I know what my co-pays are for Plan C of the ESF Medical Health & Welfare Plan?

Click here to view Plan C highlights. For a complete listing of co-pays, please refer to your Summary Plan Description (PDF, 395K).

What services require pre-notification through MagnaCare under Plan C of the ESF Medical Health & Welfare Plan?

All hospital admissions of any type and all surgical procedures performed in a hospital facility or surgi-center require pre-notification through MagnaCare. MagnaCare must be notified of any Emergency Room visit within 24 hours after the visit occurs. In addition, some specialized radiology procedures such as SPECT and PET scans and CAT scan, MRI and MRA only if performed in a hospital facility require pre-notification through MagnaCare. The toll-free number for any pre-notification through MagnaCare is 1-877-335-4725. Listen to the message prompts and press the selection for pre-notification. Specially trained nurses are available 24 hours a day, seven days per week.

What happens if the hospital does not pre-notify my admission and I am covered under Plan C of the ESF Medical Health & Welfare Plan?

It is the responsibility of the hospital to pre-notify all admissions by calling 1-877-335-4725 once you have given them the information by presenting your ID card. Remind your provider to call for pre-notification when you know that you will be admitted. If it is an emergency visit, the facility may call within 24 hours after the admission. If the hospital or surgi-center fails to call and give MagnaCare the required information, the facility will not receive payment from the Plan. The hospital/surgi-center can appeal to MagnaCare to receive payment, but it must provide all of the documentation pertinent to the admission.

How do I file a claim for expenses incurred under Plan C of the ESF Medical Health & Welfare Plan?

All claims, for services rendered by both MagnaCare and non-MagnaCare providers, must be submitted to MagnaCare at:

    MagnaCare, Inc.
    825 East Gate Boulevard
    Garden City, NY 11530

MagnaCare providers will submit the claim directly to MagnaCare on your behalf. If you use a non-MagnaCare provider, you must submit an itemized bill attached to a claim form (PDF, 64K). Expenses must be considered appropriate for insurance purposes. They must be itemized and indicate diagnosis and procedure codes (ICD9 and CPT codes).

Please note that statements that include only a previous balance, a balance due or a collection agency notice are not acceptable.

What do I do if I need to go to the Emergency Room? (ESF Medical Health and Welfare Plan)

If you believe you have a serious medical or surgical problem, such as a new onset of chest pain or severe pain in your abdomen that has been getting worse over the past several hours and you cannot reach your doctor, it is reasonable to go to the Emergency Room for assistance. The hospital must do a medical screening evaluation prior to determining your medical coverage (as mandated by federal law). After you are seen, advise the doctor/facility that they must call the MagnaCare pre-notification number within 24 hours after the visit to provide information about your diagnosis and reason for seeking emergency medical care. This information is indicated on the back of your MagnaCare card. Emergency room visits for non-emergency conditions will not be approved as medically necessary and will not be covered by the Pension, Hospitalization and Benefit Plan.

Examples of true emergencies include premature labor, significant bleeding from any site, broken bones, losing consciousness, new onset of seizures or seizures that are not being controlled and difficulty breathing.

What happens if I am out of town and admitted to the hospital? (ESF Medical Health and Welfare Plan)

As long as the admission is pre-notified and determined to be medically necessary through MagnaCare, your in-patient or Emergency Room hospital bills will be covered. All applicable co-pays will apply to such admissions.

Must I use a DDS provider for dental benefits? (ESF Medical Health & Welfare Plan)

No. You can use your dental benefits in either of the following ways:

Is there an annual maximum for dental benefits? (ESF Medical Health & Welfare Plan)

Yes. You and your eligible dependents each have a $1,500 annual maximum on all dental worked performed in a single calendar year. All charges above the $1,500 annual maximum are the patient’s responsibility, regardless of whether or not the service was performed by a DDS provider or a non-DDS provider.

Are any dental services subject to a deductible? (ESF Medical Health & Welfare Plan)

Yes. You and your eligible dependents each have an annual $50 deductible on services that are not preventative or basic.

Are there any dental services that require pre-authorization? (ESF Medical Health & Welfare Plan)

Yes. All crown, bridge, prosthetics, osseous surgery or root canal services require pre-authorization. A DDS dentist will automatically obtain pre-authorization for you. To obtain pre-authorization for services provided by a non-DDS dentist, have your dentist list the required dental work and fees on a Dental Benefit Request Form. All relevant x-rays must be attached to this form. Sign the form, and send it to DDS, Inc., located at 1640 Hempstead Turnpike, East Meadow, NY 11554. DDS will then review the case, notify the dentist of the total amount that the Plan will pay for the dental work and the portion that the patient will be responsible for. X-rays will be returned to the dentist.

What are preventative or basic services? (ESF Medical Health & Welfare Plan)

Preventative or basic services include:

I am presently collecting Workers’ Compensation or disability. How long can I remain covered under the Employees’ Security Fund Health and Welfare Plan?

Participants covered under this Plan may be covered up to 26 weeks when out on Workers’ Compensation or disability.

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Employees' Security Fund Pension Plan (for members of the Fixture, Manufacturing, or Supply Divisions)

Who is eligible for a benefit from the ESF Pension Fund?

In most cases, a participant in the Plan who has earned a minimum of five years of vesting service will be eligible to receive a benefit. However, if a participant ended work in covered employment before January 1, 1999 they will typically need 10 years of vesting service in order to be eligible to receive a benefit.

What is vesting service?

Vesting service is the length of time a participant works for a contributing employer. One year of vesting service requires a minimum of 1,000 hours of covered employment.

What types of pensions are there under the ESF Pension Fund Plan?

There are four different types of pensions. Each type of pension is eligible for the Joint and Survivor Payment Option if the participant is married. Click here for more details (PDF, 25K).

What is the ESF Joint and Survivor Payment Option?

A Joint and Survivor Payment Option (J&S Option) provides a continued payment to your spouse in the event you die prior to your spouse after you retire. Click here for details (PDF, 11K).

What happens to my ESF Pension Fund benefit if I die?

If you die before retiring, your benefit will be paid to your surviving spouse according to the 50% Joint and Survivor Benefit. If you die after you have retired and started receiving benefits from the Plan, your spouse will be paid if you elected the Joint and Survivor option.

How can I estimate the value of my pension?

Your pension benefit is based on your credited years of service multiplied by the unit benefit amount in effect at the time you retire.

For example, if you are at normal retirement age, have 20 years of credited service and retire from active employment on June 1, 2013, your benefit will be calculated as follows:
20 years of service x $22.50 = monthly benefit of $450*

*If you are married, joint survivor reductions may apply.

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Health Reimbursement Account Plan (HRA)

Does the HRA coordinate its payment with the Additional Security Benefits Plan?

Yes. When either of these plans does not have a sufficient balance when it is the primary plan, the other plan will automatically act as the secondary plan and pay any remaining balance, if funds are available. If you would like, you may opt out of this process by completing the Coordination of Benefits Form (PDF, 14K).

What kinds of medical expenses are reimbursable under the HRA?

Generally, most expenses not paid by your medical or dental plan may be submitted for payment, as well as some over the counter drugs, and Medicare, Long-Term Care and COBRA premiums. Please refer to page five of the Summary Plan Description (“SPD”) (PDF, 421K) for a comprehensive list of both covered and excluded items.

Can I take out any remaining balance from my HRA in a lump-sum when I retire or leave the industry?

No. Both active and retired participants may only receive benefit payments from this Plan for unreimbursed covered medical expenses as allowed under IRS regulations.

Is there a maximum account balance allowed under the HRA?

Yes. Your maximum account balance is based upon your collective bargaining agreement and is $5,000 unless indicated otherwise.

What happens to the employer contributions if my HRA account balance is at the maximum?

If your account equals or exceeds the maximum amount, you will not receive any further employer contributions to the HRA until you are paid benefits that are sufficient to reduce your balance below the maximum. However, you will continue to earn interest based on your account balance. Your collective bargaining agreement will state whether the excess contributions, which otherwise would have been made to the HRA and credited to your account, will be deposited in the Deferred Salary Plan or the Annuity Plan.

Am I required to exhaust my Additional Security Benefits Plan account before I access my HRA account for unreimbursed medical expenses?

No. Each participant may choose whether they want to submit an application for benefits to the HRA or the Additional Security Benefits Plan each time a claim is submitted.

What happens to my HRA account balance if I die?

Your remaining account balance will be distributed to your named beneficiary. Distributions are not subject to taxation.

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Legal Services Plan

Who is eligible for benefits from the Legal Services Plan?

All active participants who work for a contributing employer and have been employed or available for employment for at least four consecutive years immediately prior to incurring an eligible expense.

Can I use the Legal Services Plan for my family members?

The only other family member who is eligible for the Legal Services Plan is the legal spouse who is living with and not separated from the covered participant. Legal Services for children, parents or grandparents are not covered.

What services are available under the Legal Services Plan?

The Legal Service Plan includes the following services:

For more details about these covered services, as well as a list of non-covered services, please refer to the Legal Services Plan SPD (PDF, 640K).

* The Plan covers a portion of the services only. Please consult your referred attorney or the Plan for covered expenses under the elder law/estate planning benefit.

What costs are covered under the Plan?

The Legal Services Plan covers the panel attorney fee for covered services only. This benefit is taxable to the participant. Therefore, you will receive a W-2 Form at the end of the year. The Plan will not pay for additional costs associated with the legal service provided. For example, if you purchase a house, the Plan will pay the attorney’s fee, but you will be responsible for other associated costs (i.e. closing costs, appraisals, etc.).

Does the Legal Services Plan handle divorce matters?

No. The Plan does not cover matrimonial or domestic matters.

Will the Legal Services Plan cover the cost of the attorney to represent me in court?

No. If you request a panel attorney to represent you in court, the Plan will not cover this expense.

Does the Legal Services Plan have panel attorneys outside of the tri-state area?

No. Panel attorneys are referred to participants who live in New York, New Jersey, Connecticut and Pennsylvania only.

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Medical and Prescription Drug Plan (Pension, Hospitalization and Benefit Plan of the Electrical Industry) (PHBP)

I don’t understand the difference between generic, Plan-preferred brand-name and non-preferred brand-name drugs.

Generic drugs are manufactured after the original manufacturer’s patent expires. These drugs are safe, effective and FDA-approved to meet the same rigorous standards for quality, strength and purity as their brand-name counterparts. They are less expensive because the generic manufacturer does not have the investment costs of the developer of a new drug.

Plan-preferred brand-name drugs are those that do not yet have a generic equivalent available and are preferred based on safety, effectiveness and cost. An independent Express Scripts committee of physicians and pharmacists determines which brand-name drugs are preferred. They are included on a drug list know as a formulary.

Non-preferred brand-name drugs are those that do not yet have a generic equivalent, but for reasons of effectiveness or cost, are not on your Plan’s formulary drug list.

How much is my prescription drug co-pay under the PHBP Prescription Drug Plan?

Your co-pay is based on the status of your drug (generic, plan-preferred or non-preferred) and the quantity (number of days supply) you receive as well as your status as an active or retired Paticipant. Your co-pays are shown on the chart of covered services on the Medical Plan Page.

Keep in mind that you can minimize your out-of-pocket expense by speaking with your physician about prescribing a generic or Plan-preferred drug for you whenever possible. You can find information about generic drugs and pricing details online at www.expresscripts.com or by calling Express Scripts Patient Customer Service at 1-800-818-0883.

Do I need to pre-certify in order to receive prescription drug benefits?

In order to qualify for coverage, certain medications require pre-certification in order to determine the appropriateness of the drug in treating your condition. If you file your prescription through Express Scripts, their pharmacist will initiate the pre-certification review with your doctor. If you visit a retail drugstore, your pharmacist will let you know if your medication requires pre-certification. If so, your doctor must call a special toll-free number at Express Scripts to initiate a review. This process typically takes one or two business days. Once the review is complete, Express Scripts will notify you and your doctor of the decision. If the review is approved, you will receive a letter indicating the length of approved coverage. If the review is denied, the letter will include the reason for denial and instructions on how to submit an appeal if you choose.

What drugs are not covered under the Prescription Drug Plan?

The Plan does not cover weight-loss medications (such as Xenical® and Meridia®), erectile dysfunction medications (such as Cialis®, Levitra®, and Viagra®), fertility medications (such as Clomid® and Repronex®), non-sedating antihistamines (such as Allegra®, Clarinex®, and Zyrtec®), and vitamins. If one of these medications is medically necessary, you may call the Joint Industry Board Members’ Records Department at 1-718-969-4030 to obtain a form for you and your doctor to complete and submit to the PHBP Medical Plan for medical review.

Do I need to use the Express Scripts by Mail service?

Yes, if it involves maintenance medication. Once you have filled two prescriptions of the same drug at your pharmacy, you must then use the Express Scripts by Mail service for your prescriptions. Failure to do so will result in your prescription being denied at your local pharmacy.

Does the list of maintenance medications ever change?

Yes. The list of maintenance drugs is monitored by Express Scripts and changed periodically. For example, GI drugs (such as Nexium, Protonix, omeprazole) have been added to this list. Insulin is no longer on the list. Express Scripts will now advise you when your medication either goes on or comes off of the maintenance drug list. Once a drug comes off the list, you may purchase it at your retail pharmacy. Prescriptions for maintenance medications must be mailed to Express Scripts after the first fill and one refill.

My doctor requires that I take a drug that is NOT Plan-preferred and for which there are no equivalent preferred brands or generics. Do I still have to pay the highest co-pay?

If this occurs, you can call the Joint Industry Board Members Records Department at 1-718-591-2000, ext. 2491 to obtain a form to initiate a review to determine if the preferred brand co-pay applies.

If my doctor is monitoring the effectiveness of my medication, can I continue to get up to a 34-day supply from my local pharmacy until it is determined that a 90-day supply is necessary? (PHBP Medical Plan)

Yes. In this case, you can make a request to override the rule that only allows the first fill and one refill for a maintenance drug at a local pharmacy. Call the Joint Industry Board Members’ Records Department at 1-718-591-2000, ext. 2491 to obtain a form to initiate a review.

How do I know what my co-pay will be for an expense covered by the PHBP Medical Plan?

Please refer to the chart of covered services on the Medical Plan Page for co-pay amounts.

Do the PHBP Medical Plan co-pays apply if I use an out-of-network (non-MagnaCare) provider?

Yes.

What services require pre-certification through MagnaCare?

Under the PHBP Medical Plan, all hospital admissions and surgical procedures performed in a hospital facility or surgi-center require pre-certification through MagnaCare. Other services requiring pre-certification include: