FREQUENTLY ASKED QUESTIONS

I.B.E.W. Local 617 Health & Welfare

Why did the Trust Fund elect to move to a self-funded program?

On an annual basis, the Board of Trustees evaluate the renewals received from our vendor partners to determine market competitiveness. This past renewal was unacceptable and the Board of Trustees decided to market the program. After reviewing all the opportunities, the Board of Trustees decided to move to a self-funded program which provides the Board of Trustees important financial data to ensure the long term viability of the Health & Welfare program.

What is the Prudent Buyer Network?

The Prudent Buyer Network is a Preferred Provider Organization (PPO) that is owned and operated by Anthem Blue Cross of California. The Prudent Buyer Network (PPO Providers) is an organization that operates under contract with the Administrator to provide hospital, medical and surgical services at agreed upon allowances. Prudent Buyer providers are located in California.

What allowances are provided by the Prudent Buyer Network (PPO)?

Prudent Buyer Allowances is the dollar amount allowed for each particular type of medical service by Prudent Buyer Providers. Prudent Buyer providers (PPO) have agreed to accept the allowance as full payment for service for Self Funded PPO Plan members, although they will often list a higher fee.

What is UCR?

Usual Customary and Reasonable (UCR) is a range of fees which are usually charged and received for the given treatment by doctors of similar training within the appropriate geographic area.

What is my “lifetime maximum” for benefits and what is meant by the plan will restore an additional $1,500 per year?

The lifetime maximum is the total “lifetime” amount of available benefits for you under the program. Each of your dependents have their own “lifetime” maximum. The restoration benefit is an amount of $1,500 per year which will be added back (restored) each year you are covered under the plan.

What is considered to be a routine physical?

On an annual basis, you may seek the services of your provider to conduct a routine physical. A routine physical is a periodic comprehensive preventive medicine reevaluation and management of an individual.

The eligible reimbursed expenses will vary depending on the age, gender, history, examination, risk factor reduction interventions and ordering of appropriate immunizations, laboratory/diagnostic procedures.

Please explain the value of using the prescription mail order program.

For 2 times the retail co-pay, you receive 3 times the medication by using the Mail Order Service available through SavRX. It is common to use these services for ongoing needed medications.  Please contact SavRX directly at (866) 233-4239 for any questions regarding your prescription drug plan.

How are claims processed through the Prudent Buyer Network and then processed by our Administrator, United Administrative Services (UAS)?

Your Administrator, United Administrative Services (UAS), has been approved by Anthem Blue Cross of California (Prudent Buyer Network) to process claims utilizing the Prudent Buyer Network (PPO) discounts.  After seeking services through a Prudent Buyer (PPO) network, your provider will send all necessary paperwork to Prudent Buyer (PPO), who will in turn work with UAS to provide the specifics of reimbursement. UAS will process the claim and send an explanation of benefits on how the claim was processed.

What are the requirements to retire under the San Mateo Electrical Workers Health Plan?
  1.  You must have been an active eligible Participant in the Health and Welfare Plan for ten (10) out of the last fifteen (15) years and two (2) out of the last five (5) years immediately preceding the date of retirement.
  2.  You must be receiving or have recently applied for pension benefits from the San Mateo County Electrical Construction Industry Retirement Trust (IBEW Local 617).
  3.  You must be an active eligible participant in the San Mateo Electrical Workers Health Plan as of your retirement date for Retiree Health and Welfare coverage.
  4.  You must be at least 55 years of age and eligible to retire under the San Mateo County Electrical Construction Industry Retirement Trust.
I am thinking about retirement, where should I begin?

You should apply 90 days prior to your planned requested retirement date. Contact the Fund Office or the Union Office to obtain a retirement application. You must complete the application in full and provide all of the required documentation. Your requested retirement date can be no sooner than the first day of the third (3rd) month following the date the completed application is received by the Fund Office. Once the completed application is received by the Fund Office, it will be reviewed for completeness and your application will be sent to United Administrative Services (UAS). UAS will send you confirmation of your retirement date under the San Mateo Electrical Workers Health Plan. A denial letter will be sent if you do not qualify for the Retirement Plan.

What happens to the hours in my hour bank when I retire?

If you have hours remaining in your hour bank when you retire, the hour bank balance is converted to dollars by multiplying the hours left in your bank by the contribution rate in force at the time of retirement. That dollar amount is then sent by the San Mateo Electrical Workers Health Plan to UAS to be credited to your account. UAS is the administrator of the San Mateo Workers Retirement Trust. UAS will contact you directly with the coverage available and the cost of retirement plan coverage.

Please contact United Administrative Services directly at (408) 288-4400 should you have any questions on your claim. Anthem Blue Cross cannot answer questions about your specific claim.