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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.
Is more than one plan of benefits available under Plan C?
Yes, Plan C currently hosts five (5) different coverage options plus Triple S for our Puerto Rico residents. Eligible participants can choose from C1, C2, C3, C4 or the stand alone Medical Reimbursement options. All offerings are made with a single (participant only) or family (2 or more eligible family members) rate. Our Benefits at a Glance provides a side-by-side description of each option.
What is the earliest I can enroll in Plan C coverage?
New employees who have never participated in Plan C before may voluntarily enroll in Plan C once their CAPP account has enough employer contributions to meet the charge for one month of Plan C-2 individual coverage. Please note that this is after the first $150 of employer contributions for new employees is applied to the Health and Welfare Fund’s general assets.
Are there separate CAPP account charges for individual and family coverages?
Yes, since Plan C coverage is financed by your individual CAPP account, the charge for family enrollment is greater than for individual enrollment.
Can I use my CAPP balance for a purpose other than paying the cost to enroll in one of the Plan C benefit options?
Yes, if, when you reach either the voluntary or automatic enrollment thresholds and you demonstrate to the Fund Office that you have other employer or union sponsored group health coverage that meets the minimum value standards of the Affordable Care Act (ACA) you can use your CAPP account for the Plan C medical reimbursement program. Please remember there is a quarterly $60 administrative fee and you must provide proof of qualifying other coverage EVERY year along with a signed certification of the ACA requirements by the open enrollment deadline which is typically December 15th to remain enrolled in this coverage option for the next calendar year.
What if I do not make a coverage co-payment timely?
Your coverage will be automatically downgraded to the next lower level of coverage if you do not make any applicable co-payment provided there is enough money in your account to do so. You may risk losing valuable family coverage if your account balance only supports single coverage. If there is not enough money in your account to be downgraded your coverage will lapse which means your coverage terminates. You will only be allowed to continue coverage through the COBRA self-payment provision of the Plan. In order to return to coverage you will need to first meet the $150 administrative fee and then your account balance must reach one month of the current cost C3 single Please see CAPP rates for the applicable amount as these rates may change from time to time.
Why did the Trustees develop another Plan C option?
Due to provisions of the Patient Protection and Affordable Care Act (ACA) that limited the ability of individuals to participate in Plan C’s stand-alone Medical Reimbursement Program (MRP) under certain circumstances, numerous participants and Local Unions sought a lower cost alternative to Plans C1, C2, and C3.
Does Plan C4 meet the minimum value standards of the ACA?
Yes, Plan C4 is a high deductible plan that provides minimum value coverage in accordance with the ACA. C4 benefits include hospital, medical/surgical, and prescription drugs (all essential benefits). In addition, all required well care services are included with no cost sharing, and the out-of-pocket limit (this will be described in more detail later in this memorandum) meets the ACA’s requirements.
What is the cost of C4 and how does it compare to C3?
The current quarterly cost for single coverage is $902.00. The quarterly cost for a family plan is currently $1,737.00. These costs are approximately 20% less than the current C3 cost. CAPP charges may change so please check with the Fund Office for current CAPP charges.
What is the open enrollment filing/payment deadline?
All open enrollment election coupons and any applicable co-payment, must be received at the Fund Office Lockbox no later than December 15th (or the next business day if it falls on a weekend) preceding the January 1st coverage quarter.
Can I downgrade to C4 in the same year that I previously chose a higher level option?
Yes, each quarter the Fund Office sends a statement showing a participant’s available CAPP balance in advance of the prospective coverage quarter. Downgrading to a lower level coverage in Plan C is always permissible for a future coverage quarter. However, a participant cannot switch to a higher level of coverage except at each annual open enrollment unless there is a life event such as the birth of a child, adoption of a child, marriage or divorce. Please review the Plan’s Summary Plan Description booklet further for a description of such life events.