Health Fund

  > Frequently Asked Questions

Do I need to inform you that I am changing my PCP (Primary Care Physician)?Do I need a referral to see a specialist?Can I use a BCBS Provider for my routine vision exam?How do I add my spouse to the policy?What do I need to do to add my baby to the policy?I recently got divorced. How do I remove my spouse from my health insurance?Do we have any dental coverage under our Health Plan?My spouse has a health plan under his/her employer, under which both our dependent children and myself are also covered. Being that our family has two health plan policies, which plan would be the primary carrier for my spouse, our dependent children and myself?Does my Health Plan cover acupuncture?Does my Health Plan cover weight loss programs or the cost of a fitness club membership?Is pre-authorization required for inpatient hospitalization?What kind of details do I have to provide about an accident?Are charges for infertility services covered by my Health Plan?Is emergency room care covered at 100%?What are the services covered by the Annual Physical Exam benefit available to me under my Health Plan?I have received a letter from the Health Plan requesting information. Do I need to respond to this letter in writing, or may I call you and give you the information over the telephone?How are the hours for my Health Plan coverage calculated?I received a claim denial in the mail, how do I appeal this claim denial?I sent an email to you with some questions, but rather than a reply via email, you called or wrote me via regular mail to respond instead — why?

Do I need to inform you that I am changing my PCP (Primary Care Physician)? 

No, the Plan does not track your PCP.

Do I need a referral to see a specialist? 

No, the Plan does not require referrals to see specialists.

Can I use a BCBS Provider for my routine vision exam? 

No. Coverage for routine vision exams is covered by Davis Vision. In order to maximize your benefits, you should use a Davis Vision provider. For further details regarding routine vision benefits you may contact the Carpenters Vision Center at 617-782-0100. Please do not use your Blue Cross Blue Shield identification card at your vision appointment. You must advise the vision provider that your vision coverage is through Davis Vision.

How do I add my spouse to the policy? 

Please submit a copy of your marriage certificate to the Fund Office.

What do I need to do to add my baby to the policy? 

Please submit a copy of the baby’s birth certificate and a copy of the baby’s social security card to the Fund Office.

I recently got divorced. How do I remove my spouse from my health insurance? 

You must provide the Fund Office with a copy of your divorce decree. The Plan will cover an ex-spouse as required by the divorce decree; however, the Plan does not cover both an ex-spouse and a current spouse.

Do we have any dental coverage under our Health Plan? 

Certain procedures that are not covered under the Delta Dental Plan may be eligible for coverage under the Health Plan.

My spouse has a health plan under his/her employer, under which both our dependent children and myself are also covered. Being that our family has two health plan policies, which plan would be the primary carrier for my spouse, our dependent children and myself? 

The Plan has rules that determine which plan is primary. Refer to the section called Coordination of Benefits in your Summary Plan Description for details.

Does my Health Plan cover acupuncture? 

Yes, but only when the acupuncture is performed by a Medical Doctor.

Does my Health Plan cover weight loss programs or the cost of a fitness club membership? 

No, your Plan does not cover weight loss programs or the cost of a fitness club membership.

Is pre-authorization required for inpatient hospitalization? 

Yes. You, the hospital or physician must contact Blue Cross Blue Shield at 800-327-6716. If you do not receive pre-authorization, your hospital claim will not be paid.

What kind of details do I have to provide about an accident? 

You must provide a description of the injury, as well as how, when and where the accident occurred. This information must be submitted to the Fund Office from you in writing. You may fax the information to the Health Claims Department at 978-657-8724 or mail it to NE Carpenters Health Fund, 350 Fordham Road, Wilmington, MA 01887.

Are charges for infertility services covered by my Health Plan? 

Yes. Benefits for infertility are covered up to a lifetime maximum of $5,000.

Is emergency room care covered at 100%? 

No. You are responsible for paying both a deductible and co-insurance to the provider/facility.

What are the services covered by the Annual Physical Exam benefit available to me under my Health Plan? 

The Annual Physical Exam Benefit for our member and spouse allows up to a $250 calendar year maximum for the exam, all routine/preventive care tests and all routine/preventive immunizations (including the flu vaccination).

I have received a letter from the Health Plan requesting information. Do I need to respond to this letter in writing, or may I call you and give you the information over the telephone? 

All information requesting must be submitted in writing to the Fund Office. You may fax the information we need to the Health Fund at 978-657-8724 or mail it to NE Carpenters Health Fund, 350 Fordham Road, Wilmington, MA 01887.

How are the hours for my Health Plan coverage calculated? 

There are two six-month work periods and two six-month coverage periods under the Health Plan. The hours you work from February 1st through July 31st are used to determine your Health Plan eligibility for the coverage period of October 1st through March 31st. The hours you work from August 1st through January 31st are used to determine your Health Plan eligibility for the coverage period of April 1st through September 30th.

I received a claim denial in the mail, how do I appeal this claim denial? 

You may appeal the denial in writing to the Fund Office. You may fax your written appeal to the Health Fund at 978-657-8724 or mail it to NE Carpenters Health Fund, 350 Fordham Road, Wilmington, MA 01887.

I sent an email to you with some questions, but rather than a reply via email, you called or wrote me via regular mail to respond instead — why? 

Email is not a secure method for transmitting your protected health information, and for that reason, we cannot respond to you via email. Your protected health information includes your name, address, ID number(s), date of birth, health claim related information, among many other key pieces of information. The Fund is diligent in its efforts to protect your information, we take your privacy very seriously, and do our very best not to jeopardize your information. While email is a convenient method of communication for everyone, it is not protected and therefore unsafe to use as a method of communication.