NW Plumbers & Pipefitters Health Fund

COBRA (the Consolidated Omnibus Budget Reconciliation Act) is a federal law that requires group health plans to provide temporary continuation of group health coverage that otherwise might be terminated. For example:

• You lose or quit your job
• You divorce the employee
• The employee dies
• You are no longer covered as a dependent due to your age

Initial COBRA notices are mailed to all new participants who recently gained Health coverage under the Trust. This notice explains your COBRA rights.

If you do not have enough contributions built up in your dollar bank for at least one additional month of coverage. The cobra election form gives you the option to self-pay for coverage in the months that you do not have coverage based on active employment. If you are currently working full time, you will probably have enough hours reported to continue your coverage without a break. *Members can always call at the end of the month, prior to losing coverage to confirm the hours and confirm eligibility.

You can either call or email the administration office for a booklet or they are available on the Trust website.

Balance-billed charges, health care this plan doesn’t cover, vision services, alternative provider benefits, non-PPO coinsurance, expenses in excess of usual, customary and reasonable (UCR), benefits for foot orthotics, non PPO hospital copay and penalty and expenses in excess of Plan limits.

All in-patient hospital admissions (emergency admissions must be pre-authorized by the next business day following admission). Certain outpatient procedures also require pre-authorization. A complete list of those services can be found in the benefit booklet or by calling Qualis Health at the number below in the next Q&A.

Qualis Health at 800-783-8606

Premera Blue Cross (WA and AK), Blue Card-Blue Cross in all other States (Does not apply to Medicare Retirees or Medicare eligible dependents).

Visit www.premera.com, login as a visitor and select the Blue Card PPO option or call 800-810-2583.

Your identification number is listed on your ID card. Your identification number begins with the letters FIT.

Submit medical and vision claims for any service by Premera contracted providers, or any provider in WA or AK:

Premera Blue Cross
P.O. Box 91059
Seattle, WA 98111-5159

Submit claims for services outside of WA or AK to the local Blue Cross Plan.

Submit Medicare*, member paid claims, dental* and time loss claims:

NW Plumbers Trust
P.O. Box 34684
Seattle, WA 98124-1684

*Medicare and Dental claims can be submitted electronically through Change Healthcare Group F31 payer ID 91136. Note: Medicare claims are routed through the Medicare Cross Over program.