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FAQ

The answers to frequently asked questions below are general in nature and do not modify the terms of their respective Plans. You should refer to the related Summary Plan Description for more specific information regarding each Fund's Plan.

Top Frequently Asked Questions

What if I am currently enrolled in Medicare? How am I affected?

The National Health & Welfare Fund recently sent you a notice advising that the Board of Trustees has created a separate MRP Plan designed solely for retired Plan Participants who are on Medicare. It is called the Retiree-Only Medical Reimbursement Program (“MRP”) Plan. As of January 1, 2014, a Medicare enrollee’s Plan C CAPP account balance (with employer contributions received through October 31, 2013) will be converted to a Retiree-Only MRP account, unless the individual (i) is deemed active by current Plan rules at January 1, 2014, (ii) timely enrolls in active coverage (Plan C-1, C-2 or C-3), or (iii) timely submits an election form requesting that his or her Plan C CAPP account balance stay in the Active Plan for purposes of obtaining such coverage in the future, in addition to his or her Medicare coverage.

Is the MPIPHP coverage considered group health coverage?

Yes. Any group health plan coverage obtained through your employment or employment of your spouse or partner is acceptable “other group health coverage” for purposes of enrollment in the stand-alone MRP Plan, provided that you submit the required proof of other coverage and certify that the other coverage meets the ACA’s minimum value standard. You can check with your Plan Sponsor (typically your employer) or the insurance carrier whether the other coverage meets the minimum value standard. All benefit funds and insurance companies are required to issue SBCs (Summary of Benefits and Coverage) that indicate whether the plan of benefits meets the minimum value standard pursuant to the ACA’s requirements. The SBC will indicate that at the top of the form.

What do I need to provide to the National Health & Welfare Fund in order to continue to enroll in, or elect to enroll in, the MRP Plan option for this year’s open enrollment?

You must send a front and back copy of your other insurance/coverage identification card along with the checked box and signed certification form that will be on your year-end statement or enrollment form. Your identification card must state that it is a group plan or have a group identification number on it (with the word “group” prominently displayed) or you must obtain a letter from your plan sponsor (typically, employer) or the insurance carrier stating that you are enrolled in an employer/union sponsored group health plan.

If coverage is cheaper on the Marketplace, can I waive my current coverage and purchase coverage on the Marketplace?

You may not waive coverage under the Fund’s Plan C-1, C-2, or C-3 options. You may only waive an MRP balance if you are enrolled in the MRP Plan on a stand-alone basis. The only advantage to waiving an MRP balance is that this may allow you to qualify for a federal subsidy for coverage purchased through the Marketplace. We cannot offer guidance on this issue, since the subsidy is based on total household income, which is information that this Fund does not have.

If I incurred claims during 2014 for which I want reimbursement in 2015 do I have to be enrolled in the MRP option in 2014 to make a claim?

 Yes, you must be enrolled in the active stand-alone MRP option at the time of the claim submission.  If you are covered under Plans C-1, C-2, C-3, or C-4 in 2015 and have excess funds in your CAPP account available for reimbursement, then you can submit for reimbursement any claims incurred during 2014 as long as they are postmarked by March 31, 2015.  As of January 1, 2014, in accordance with ACA requirements, the following expenses are NOT eligible for reimbursement under the MRP:  individual health coverage premiums, as well as amounts to cover deductibles, co-insurance or excluded items as determined by an INDIVIDUAL health insurance plan that you may have had in 2014.    

If I was enrolled in the stand-alone active MRP Plan through December 31, 2014 but are not enrolled in that option for January 1, 2015 do I still have until March 31, 2015 to submit my 2014 incurred claims for reimbursement?

 No.  Under the Plan rules, the claim for reimbursement must have been incurred while you were enrolled in the MRP Plan and must be submitted at a time while you are still enrolled in the MRP Plan.  In addition, as explained above, as of January 1, 2014, the ACA prohibits HRAs (like the MRP Plan) from reimbursing individual health plan premiums [or any cost-sharing under such an individual plan (deductibles, co-payments, etc.).  Your 2014 claims must be postmarked before the end of 2014 in order for them to be eligible for reimbursement.]

What happens if I have a loss of coverage during the year?

If you lose coverage under Plans A, C-1, C-2, or C-3, you will be offered COBRA (self-pay continuation coverage). You have the right to purchase COBRA continuation coverage through the National Health & Welfare Fund until you re-qualify for coverage through employer contributions. Instead of electing and paying for COBRA coverage, you may wish to obtain coverage through the Health Insurance Marketplace. With either COBRA or Marketplace coverage, you should avoid a tax penalty for being uninsured.

How long can I be without coverage before a tax penalty for being uninsured is imposed?

As long as your period of being uninsured is less than three (3) months and only occurs once in a calendar year then the IRS will not impose a penalty on you. Since the Health Fund’s coverage runs in quarters, a loss of coverage will be equal to, and in some cases greater than, three months. Therefore, to avoid a tax penalty you should exercise your right to obtain coverage through COBRA (by making a timely election and payment) or purchase coverage through the Health Insurance Marketplace.

What does minimum value mean?

In general, the ACA’s minimum value requirement means that your group health coverage must cover at least 60% of plan costs.

What does ‘affordable’ mean as per the ACA?

Affordable means that any payment you make for your individual coverage only (excluding any cost to cover your dependents) cannot exceed 9.5% of your total household income. Since the Fund does not maintain information about your total income or that of your entire household we would be unable to guide you as to whether or not coverage through one of our Plan options or that of another group fits the government’s definition of affordable.


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