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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

I am enrolled in Medicare, what are my Plan options?

  • If you have stopped working (retired) and you have a Plan C CAPP balance, you can enroll in the Retiree Medical Reimbursement Program (R-MRP). See the Retiree MRP Plan Summary Plan Description for specific rules. Your Medicare coverage(s) will be your primary coverage.

  • If you are still working, even sporadically, and your employer contributions in a quarter (plus your balance) equals or exceeds the Plan’s current cost of C4 Single, the you must, in accordance with CMS (Medicare) rules, enroll in Plan coverage and your Medicare coverage(s) will be secondary 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.

How do I enroll in the stand-alone MRP option?

Annually, you must provide the following:

  1. Front and back copy of your other employer or union sponsored group health coverage ID card which clearly states GROUP coverage on the card.
  2. OR, a letter from your Plan-sponsor stating you are enrolled in an employer or union sponsored group health plan that meets the Affordable Care Act (ACA) minimum value standard
  3. The signed certification that comes with your annual open enrollment statement
  4. If you are enrolling on-line via the Funds website, there is an on-line certification that you electronically sign and you can upload your ID card or your plan sponsor letter.

Can I waive Plan coverage and buy coverage on the Marketplace?

No! You may not waive coverage under the Fund’s Plan C1, C2, C3, C4 or Triple S options.

Can I submit a reimbursement claim from last year if I am no longer enrolled in the MRP Plan?

No. You must incur the claim while enrolled in MRP AND reimbursement can only be made if you are enrolled in the MRP Plan at the time the claim is received.

If you incurred the claim while enrolled in the MRP Plan and submit it while you are in active coverage but you have excess balance available for reimbursement, you have 12 months from the date of service to submit the claim or if incurred with excess balance available and submitted when enrolled in MRP or with a continuing excess balance, you have 12 months from the date of service to submit that claim for reimbursement.

What is the filing deadline for reimbursement of qualified previously unreimbursed medical expense claims?

12 months from the date of service.

What happens if I, or one of my dependents, has a loss of coverage?

If you lose coverage under Plan A, C1, C2, C3, C4 or Triple S, you, or our dependent, 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, qualify for another group health coverage plan or exhaust the time limit for continuation. 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 may avoid a tax penalty for being uninsured. Check with your personal tax advisor to be certain.

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 other employer or union sponsored group health coverage plan pays at least 60% of the total cost of medical services coverage by that plan.

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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