FAQs

Eligibility

You are eligible for Teamsters Security Fund for Southern Nevada—Local 14 health & welfare benefits if you are:

  • An active employee of a participating employer, you have met the initial eligibility requirements (first day of the month after receipt of your Employer’s first contribution made on your behalf), and you have maintained continuous eligibility, or
  • A retiree of a participating employer who has maintained continuous eligibility and is not yet eligible for Medicare. The retiree must have been eligible as an active employee, or through COBRA, for 96 of the 120 months immediately before retirement.

Your eligible dependents include:

  • Your legal spouse: if you choose to cover your spouse, you will need to submit a Spousal Affidavit.
  • Your children up to age 26, including:
    • Natural children
    • Stepchildren
    • Legally adopted children
    • Children placed for adoption
    • Children for whom you are the court-appointed guardian.
  • Your unmarried disabled adult child

Login at www.teamsters14healthfund.com  and click on Health Eligibility in the left menu.

Enrollment

To enroll for health & welfare benefits, complete and return an Enrollment Form and Spousal Affidavit (if applicable) to the address on the form. Complete all sections of the form and enclose any required documents for your dependents.

To cover your spouse, you will need to submit a Spousal Affidavit, included in your enrollment materials, indicating whether your spouse has the option to enroll in other group medical coverage through a current employer.

If your spouse has the option to enroll in other group medical coverage but does not elect it and continues to have the Fund’s medical plan as primary coverage, you will need to pay a $300 monthly spousal premium. An invoice with payment information will be mailed to you.

If your spouse does not have the option to enroll in other group medical coverage or is enrolled in his or her employer’s health plan as primary and in the Fund’s health care plans as secondary, you will not be required to pay a monthly spousal premium, as long as you complete the Spousal Affidavit.

If you certify that your spouse does not have the option to enroll in other group coverage and enroll him or her in the Fund’s medical plan, then later it is determined that your spouse was or had the option to enroll in other group medical coverage, you will need to pay the $300 spousal monthly premium for each month it should have been applied, plus you may have to pay the Trust Fund back for any benefits that were improperly paid for your spouse.

This plan is a preferred provider organization (PPO). It gives you the flexibility to see any medical provider. However, you save money when you use in-network providers. Refer to your Summary Plan Description for details on this plan. This plan is self-funded, which means the Fund is responsible for claims costs for participants’ eligible health care services, not Anthem or Zenith American Solutions.

This plan is a health maintenance organization (HMO). You must always see Health Plan of Nevada providers in order to receive coverage, except for life-threatening emergencies. This plan is fully insured, which means Health Plan of Nevada pays the claims for participants’ eligible health care services.

You can change your benefit elections during Open Enrollment. Changes you make during Open Enrollment each year are effective the following January 1. Outside of Open Enrollment, you are only able to make changes within 60 days of experiencing a qualifying life event, such as getting married or divorced, having a baby, or your spouse losing coverage under his or her own plan.

To enroll dependents, send copies of the following documents along with your completed Enrollment Form:

  • Spouse: Spousal Affidavit and Certified Marriage Certificate
  • Children/stepchildren: Certified Birth Certificate or court-appointed guardianship certificate; divorce decree for stepchildren, if applicable

If your dependents lose eligibility for coverage due to divorce, legal separation or death, you must notify the Fund by sending a copy of one of the following documents along with an updated Enrollment Form:

  • Divorce decree
  • Legal separation papers, or
  • Death certificate

Note that you must list the Social Security number for all dependents on the Enrollment Form.

Claim Status

When you receive care from either an in-network or non-network provider, show your Medical ID Card to your provider, who will submit the claim for you. Note that out-of-network benefits will apply for non-network providers.

If your claim involves an accident or injury, the PPO Plan administrator needs additional information before it can process the claim, such as how and where the accident or injury occurred and whether anyone else was involved. This can affect who pays the claim. Medical providers do not include this information when they submit their claims, so the administrator will contact you to obtain it.

Login at www.teamsters14healthfund.com and click on Claim Status in the left menu.

Plan Benefits

If you visit the emergency room for non-life-threatening treatment, the PPO Plan pays $75 of emergency room charges and you pay the balance; the HMO Plan pays nothing in this case.

If you’re in the PPO Plan:

  • See the list of urgent care centers in your enrollment packet, use the Anthem mobile app or visit anthem.com to find a facility near you.
  • Or consider using LiveHealth Online to connect with a doctor 24/7 via two-way video on your smartphone, tablet or computer. You’ll only have a $10 copay for this service. Visit livehealthonline.com or download the LiveHealth Online mobile app for free from the App Store or Google Play.
  • Or request urgent care services where you need them – at your office, home, or anywhere else. You’ll have only a $15 copay for this service. Visit dispatchhealth.com, call (702) 848-4443, or download the Dispatch Health app for free from the App Store or Google Play.

If you’re in the HMO Plan:

  • Visit a Health Plan of Nevada contracted urgent care facility listed at myhpnonline.com.
  • Or, consider using telemedicine. Visit myhpnonline.com and follow the instructions under NowClinic® Virtual Visits.

Under the PPO Plan, you can use BlueCard® to access benefits and receive healthcare services while traveling or living outside the PPO Plan service area. BlueCard links participating providers and BlueCross BlueShield Association Plans across the United States through a single electronic network for claims processing and reimbursement. For more information, call (702) 851-8286.

Under the HMO Plan, you have coverage while traveling if you visit a Health Plan of Nevada contracted urgent care facility listed at www.myhpnonline.com. You also have emergency room coverage, but keep in mind that the HMO Plan pays nothing if your visit is for a non-life-threatening emergency.

We encourage all members to get preventive care services, which are covered by both medical plans at 100%. Early detection is often key to treatment of many diseases and conditions that cause serious illness or even death. Spending a relatively small amount of time now can save you a lot of time, money, and discomfort in the future. Both the PPO and HMO Plans cover preventive care for you and your family at no charge to you, as long as you see in-network providers. This includes services such as physical exams, certain immunizations, and preventive screenings and services based on your age and risk factors—such as a flu shot, colonoscopy, PSA test for men, or mammogram or pap smear for women. For a list of covered preventive care services, visit anthem.com for the PPO Plan or www.myhpnonline.com for the HMO Plan.

Generic drugs have a $5 copay under the PPO Plan and are half the cost of preferred brand drugs under the HMO Plan. Since generic drugs use the same active ingredients and are proven to work the same way as their brand-name counterparts, they have the same risks and benefits. However, doctors don’t always automatically prescribe generic drugs. Be sure to ask whether a generic is available.

If you take medications on a regular basis for chronic conditions such as high blood pressure, arthritis, diabetes, and asthma, use the mail order service to save money on prescriptions. Depending on which plan you’re in and the type of drug, your copays for a 90-day supply may be lower than the same supply from a retail pharmacy, plus you get the convenience of home delivery.

Here’s how to get started with mail order:

Precertification assures that your health care services meet or exceed accepted standards of care and that the admission and length of stay in a hospital or health care facility, surgery, drug, dental service or other health care services are medically necessary. If you’re in the PPO Plan, you will need to precertify certain medical services; see the Summary Plan Description for a complete list. To start the precertification process, contact Innovative Care Management (ICM) at:

P.O. Box 22386
Portland, OR 97269
Phone: 1-800-862-3338
Website: www.innovativecare.com

How to Locate In-Network Providers

Keep in mind that we have different provider networks for hospital, mental health/substance abuse, prescription drugs, and other types of medical care. When you need services, choose the right network:

  • Hospitals: Choose Hospital Coalition providers from the list at lvhsc.org.
  • Mental health/substance abuse treatment: Call Harmony Healthcare at (702) 251-8000 or visit harmonyhc.com for an online provider directory.
  • Prescription drugs: Access the EnvisionRx Pharmacy Locator at envisionrx.com or call 1-800-361-4542.
  • All other providers: Visit anthem.com and click “Find a Doctor” under “Menu.” Under “Search as a Member,” enter “JTF” below “Identification number or alpha prefix,” then click “Continue” and follow the instructions.

To find a VSP doctor near you, visit www.vsp.com and click on “Find a VSP doctor” or call 1-800-877-7195.

To find an in-network dental provider,

  • Delta Dental PPO Plan: Visit deltadentalins.com, and use the “Find a Dentist” search box.
  • LIBERTY Dental Plan DHMO-EPO (Benefit Plan NV-400): See the provider list in your enrollment packet, or visit libertydentalplan.com and click the “Find a Dentist” tab and select NV-100 through NV-700 from the Benefit Plan drop-down menu, then follow the instructions. You may also call LIBERTY Dental Plan at 1-888-401-1128.

If you’re in the PPO Plan, use LiveHealth Online to connect with a doctor 24/7 via two-way video on your smartphone, tablet or computer. You’ll only have a $10 copay for this service with no deductible. Visit www.livehealthonline.com or download the LiveHealth Online mobile app for free from the App Store or Google Play.

If you’re in the HMO Plan, visit www.myhpnonline.com and follow the instructions under NowClinic® Virtual Visits.

Employee Assistance Program

The EAP, offered through Harmony Healthcare for all members and their immediate families includes:

  • Mental Health and Substance Abuse Treatment Authorization
  • Confidential Counseling Visits for Personal and Family Concerns: up to four free visits

To schedule an appointment, call Harmony Healthcare at 1-800-363-4874 or (702) 251-8000, 24 hours a day, seven days a week.

Life and AD&D Benefits

Teamsters Security Fund for Southern Nevada—Local 14 provides the following life and accidental death & dismemberment insurance (AD&D) coverage through Ullico:

  • Active employees: $25,000
  • Dependents of active employees (must be listed on the policy): $10,000
  • Retirees who have maintained continuous eligibility and are not yet eligible for Medicare: $10,000.

Note that dismemberment coverage may be different than life insurance coverage. Contact the Teamsters 14 Customer Service Line for details, at (702) 851-8286.

You can apply for life and/or AD&D benefits by contacting the Teamsters 14 Customer Service Line at (702) 851-8286.

Retiree Medical Coverage

The Teamsters Security Fund for Southern Nevada—Local 14 provides retiree coverage to eligible non-Medicare participants and their dependents. The retiree must have been eligible as an active employee, or through COBRA, for 96 of the 120 months immediately before retirement. If you live in the Health Plan of Nevada (HPN) area, you may only enroll in the HMO Medical Plan. If you live outside the HPN area, you may only enroll in the Indemnity (PPO) Medical Plan.

Retiree coverage includes medical, pharmacy, dental, and vision benefits. Life and AD&D insurance coverage of $10,000 is included for members only.

Once you are eligible for Medicare, Via Benefits (One Exchange) is available to assist you in locating medical, prescription drug, dental, and supplemental life and accident insurance plans. Contact them by calling 1-888-825-2645 or visiting ViaBenefits.com/lasvegasteamsters.

Complete the Retiree Enrollment Form, which you should have received in your Retirement Packet. Confirm the premium you will pay for your medical and dental plan choices on the Retiree Enrollment Acknowledgement Form. Return the Enrollment Form, the Enrollment Acknowledgement Form and a copy of your Pension Benefit Award Letter to Zenith American Solutions.

ID Cards

If you are enrolled in the PPO Plan and have not received your ID Card and sleeve in the mail, contact Zenith-American Solutions at (702) 851-8286 to request them. If you are enrolled in the HMO Plan and have not received an ID Card in the mail, contact Zenith-American Solutions or Health Plan of Nevada at 1-800-777-1840.

Appeals

For claims administration and appeals related to the PPO Plan (including prescription drug and behavioral health claims), the Delta Dental PPO Plan, and vision care benefits, refer to Claim Filing and Appeal Information in the Summary Plan Description. If you receive an Adverse Benefit Determination for one of these claims, you may appeal it to the Board of Trustees.

For claims administration and appeals under the Health Plan of Nevada HMO Plan, the Liberty Dental Plan DHMO-EPO, and the Prudential Life and Accident Insurance Plan, refer to the official documents of these insurance companies.

 

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