HEALTH & WELFARE

IMPORTANT RESOURCES

DELTA DENTAL PLAN
EFFECTIVE 1-1-2022
Delta Dental Find Dentist Onine Tool
Member Connection - Delta Dental
Delta Dental App - Phone or Tablet
Mobile App Flyer
TeleDentistry Flyer

CVS Caremark
Click Here to Learn about your Pharmacy Benefits with CVS Caremark.

IRS 1095B FORMS

MACHINE READABLE FILES
Click Here to Access Link to Machine Readable Files

Green Light Price Comparison Tool
Click Here to Access the Green Light Price Comparison Tool

Employee Resources Systems (ERS)


Click Here for a brief Video on what services ERS provides

Click Here for a brief Video on ERS Member Web Portal and APP

ERS - Benefits Flyer (English)
ERS - Benefits Flyer (Spanish)

UHS
Physicians Directory
Top Health Newsletter
Top Health Newsletter (Spanish Version)
Top Health Newsletter (Polish Version)
2024 SBC PLAN A
Disability Form
Initial Report of Claims Form
Subrogation Agreement
Subrogation Questionnaire

EYEMED



2024 LASIK Member Flyer

2024 Member Special Offers Member Flyer
EyeMed Mobile App Flyer
Eyemed-Know Before You Go Member Flyer
EyeMed Benefit Summary
EyeMed Benefit Summary (Spanish)

FORMS

Complete this form to change your mailing address, and return to the Fund Office.

In order to change your mailing address, you must complete this form, and return to the Fund Office.

If you want the Plan to disclose your protected health information to another individual(s), class of persons, or organization of your choice (for example, your spouse), complete this form and return to the Fund Office. If your spouse and/or Dependent child(ren) over the age of 17 (i.e. Dependent child(ren) who are at least 18 years old) want the Plan to disclose their protected health information to you, they also must fill out this form and return it to the Fund Office.

If the Fund Office has an incorrect social security number for you, you must complete and return a notarized form along with a copy of your social security number card to the Fund Office.

Complete this form to acknowledge the Fund’s subrogation and reimbursement interests. For more information, please contact the Fund Office.

If you become disabled and are unable to work, you and your physician must complete this form and submit it to the Fund Office, in order to receive the weekly disability benefits.

Once approved for the weekly disability benefit, to continue to receive the weekly disability benefit, you will be responsible to complete this form.

Please refer to Page 1 of the document for thorough form instructions and information.

FREQUENTLY ASKED QUESTIONS

Contact the Fund Office and ask to speak with an Accounts Receivable Specialist. They will verify eligibility and request a new health & welfare ID card. Your new ID card will arrive within 10-15 business days from the date you notify the Fund Office that you need a new card.
The Important Contact Information page under the Schedule of Benefits provides contact information for the various benefits provided by your Plan.

Non-Supplemental Plan A Schedule of Benefits
Non-Supplemental Plan B Schedule of Benefits
Supplemental Plan A Schedule of Benefits
Supplemental Plan B Schedule of Benefits
If you need to obtain a copy of your EOB contact the Fund Office.
If you receive services from a non-participating provider you may have to submit the claim to the Plan. If you need to submit a claim, you will need to request an itemized bill from the provider and provide this invoice to the Fund Office.
In order to change your mailing address, you must complete a Change of Address Form. You may print and complete the form, or you may contact the Fund Office and a form will be mailed to you.
To enroll your spouse for coverage under the Plan, submit a completed Dependent Enrollment Form along with the required documentation (see below) to the Fund Office. You have 30 days from the date of your marriage to notify the Fund Office. Once notification is received benefits will be paid retroactively to the date of your marriage. If you do not notify the Fund Office, in writing, within 30 days of your marriage, your spouse’s coverage will not begin until the first day of the month following the month in which you notify the Fund office.

To enroll your dependent child for coverage under the Plan, submit a completed Dependent Enrollment Form along with a copy of the birth certificate or adoption papers to the Fund Office. You must enroll your child for coverage before the Fund pays any benefits for that child.

With respect to an adoption, placement for adoption, or placement of a foster child, if you notify the Fund Office, in writing, within 30 days of your dependent becoming eligible, benefits will be paid retroactively to the date your dependent became eligible. If you do not notify the Fund Office, in writing, within 30 days, your dependents coverage will not begin until the first day of the month following the month in which you notify the Fund Office.

With respect to a newborn child, if you notify the Fund Office, in writing, within 60 days of the birth, benefits will be paid retroactively to the date of birth. If you do not notify the Fund Office in writing, within 60 days, your newborn child’s coverage will not begin until the first day of the month following the month in which you notify the Fund Office.
Required documents for enrollment includes (but may not be limited to) the following:
  • Government-issued identification
  • With respect to a spouse, a marriage certificate AND ONE of the following documents
    1. a.) Page 1 and signature page of the employees most recent federal income tax return
    2. b.) A document dated within the past six months such as a mortgage statement, loan papers, lease agreement, automobile registration, or credit card or account statement in the name of both the member and spouse.
  • With respect to a dependent child, a birth certificate, court order or certificate of adoption
Same sex marriage is recognized only under the supplemental plans C or D. Contact the Fund Office for more information.
Submit a completed Initial Report Form to the Fund Office.
The Schedule of Benefits is the document that details the benefits of the health plan. The schedule of benefits document will provide information about the health plan such as the applicable co-pay amounts, deductible amounts, and out of pocket maximums.

Non-Supplemental Plan A Schedule of Benefits
Non-Supplemental Plan B Schedule of Benefits
Supplemental Plan A Schedule of Benefits
Supplemental Plan B Schedule of Benefits
You will receive your medical card 10-15 business days from the end of the month, following receipt of the required contributions to be eligible for benefits.
You can review the Summary Plan Description electronically or you can call the Fund Office to request a hardcopy of the SPD Booklet.

Non-Supplemental Plans A and B Summary Plan Description (SPD)
Supplemental Plans A and B Summary Plan Description (SPD)
Doorstaff Summary Plan Description (SPD)
You or your spouse must notify the Plan and mail a fully executed copy of your divorce decree to the Fund Office. Once the Plan receives the divorce decree, your former spouse’s coverage will be terminated back to the date of your divorce.
The plan does not offer a retiree health and welfare benefit.
If you have any questions, contact the Fund Office at (630) 288-6868 or (866) 844-0488.
The Important Contact Information page under the Schedule of Benefits provides contact information for the various benefits provided by your Plan:

Non-Supplemental Plan A Schedule of Benefits
Non-Supplemental Plan B Schedule of Benefits
Supplemental Plan A Schedule of Benefits
Supplemental Plan B Schedule of Benefits

PLAN DOCUMENTS & NOTICES

The SPD summarizes the key provisions of the Plan and includes important information about your benefits from the Plan.
Non-Supplemental Plans A and B Summary Plan Description (SPD)
Supplemental Plans A and B Summary Plan Description (SPD)
Doorstaff Summary Plan Description (SPD)

Summary of Material Modifications (SMM)
The Summary Plan Description is updated from time-to-time and therefore includes additional information and changes to the Plan in an SMM.

Summary of Material Modifications (SMM)
Coverage for drug testing
The Summary Plan Description is updated from time-to-time and therefore includes additional information and changes to the Plan in an SMM.

Summary of Material Modifications (SMM)
COVID Member Communication
The Summary Plan Description is updated from time-to-time and therefore includes additional information and changes to the Plan in an SMM.

Summary of Material Modifications (SMM)
COVID Update, Telehealth Coverage
The Summary Plan Description is updated from time-to-time and therefore includes additional information and changes to the Plan in an SMM.

Summary Annual Report
The Summary Annual Report provides insurance and basic financial information regarding the Plan and informs you of your rights to additional information.

Non-Supplemental Plan A
This document provides you with a quick reference to covered expenses, deductibles and out-of-pocket costs. This is not a full explanation of the benefits covered by the Plan. For more information about the benefits covered by the Plan, see the enclosed Summary Plan Description and Benefit Alerts.

Non-Supplemental Plan B
This document provides you with a quick reference to covered expenses, deductibles and out-of-pocket costs. This is not a full explanation of the benefits covered by the Plan. For more information about the benefits covered by the Plan, see the enclosed Summary Plan Description and Benefit Alerts.

Supplemental Plan A
This document provides you with a quick reference to covered expenses, deductibles and out-of-pocket costs. This is not a full explanation of the benefits covered by the Plan. For more information about the benefits covered by the Plan, see the enclosed Summary Plan Description and Benefit Alerts.

Supplemental Plan B
This document provides you with a quick reference to covered expenses, deductibles and out-of-pocket costs. This is not a full explanation of the benefits covered by the Plan. For more information about the benefits covered by the Plan, see the enclosed Summary Plan Description and Benefit Alerts.

Notice of Creditable Coverage/ Medicare Part D
This notice contains information about your current prescription drug benefits and coverage.

This notice includes important information about protections for individuals who elect breast reconstruction in connection with a mastectomy. In addition, this notice informs you how you can request a copy of the Fund’s Privacy Notice. You will also receive this notice annually, via US Mail.

LIFE EVENTS

Birth or Adoption

To enroll your dependent child for coverage under the Plan, submit a completed Dependent Enrollment Form along with a copy of the birth certificate or adoption papers to the Fund Office. You must enroll your child for coverage before the Fund pays any benefits for that child.

With respect to an adoption, placement for adoption, or placement of a foster child, if you notify the Fund Office, in writing, within 30 days of your dependent becoming eligible, benefits will be paid retroactively to the date your dependent became eligible. If you do not notify the Fund Office, in writing, within 30 days, your dependents coverage will not begin until the first day of the month following the month in which you notify the Fund Office.

With respect to a newborn child, if you notify the Fund Office, in writing, within 60 days of the birth, benefits will be paid retroactively to the date of birth. If you do not notify the Fund Office in writing, within 60 days, your newborn child’s coverage will not begin until the first day of the month following the month in which you notify the Fund Office.

Marriage

When you marry, your spouse is eligible for healthcare coverage as of the date of your marriage. However, the Fund will not pay benefits on behalf of your spouse until you enroll your spouse for coverage. To enroll your spouse for coverage under the Plan, submit a completed Dependent Enrollment Form along with the required documentation (see below) to the Fund Office. You have 30 days from the date of your marriage to notify the Fund Office. Once notification is received, benefits will be paid retroactively to the date of your marriage. If you do not notify the Fund Office, in writing, within 30 days of your marriage, your spouse’s coverage will not begin until the first day of the month following the month in which you notify the Fund office.

Required documents for enrollment includes (but may not be limited to) the following:

  • Government-issued identification
  • With respect to a spouse, a marriage certificate AND ONE of the following documents
    • Page 1 and signature page of the employees most recent federal income tax return
    • A document dated within the past six months such as a mortgage statement, loan papers, lease agreement, automobile registration, or credit card or account statement in the name of both the member and spouse.
  • With respect to a dependent child, a birth certificate, court order or certificate of adoption

Disability

If you are unable to work as a result of a non-work related injury or illness and you are under the care of a physician, you may be entitled to the weekly disability income benefit. To apply, submit a completed Disability Claim Form to the Fund Office. Once approved for the weekly disability benefit, you will be responsible to complete the Weekly Disability Supplementary Form.

Moving

If you have recently moved, please complete a Change of Address Form.

Loss of Employment/Coverage

If coverage is lost due to lack of sufficient employer contributions and hours in your individual record system, then you will have the option to elect to continue coverage under COBRA for up to 18 months. Please contact the Fund Office with questions relating to your eligibility.

Divorce

If you and your spouse get a divorce or legal separation, your spouse will no longer be eligible for coverage. However, a spouse may elect to continue coverage under COBRA for up to 36 months upon divorce or legal separation. You or your spouse must notify the Fund Office, within 60 days of the divorce or separation date for your spouse to obtain COBRA continuation coverage. You must also submit a copy of the divorce decree to the Fund Office.

Retirement

If you meet certain criteria defined in the health & welfare Summary Plan Description you and your family may be eligible to participate for regular retiree plan or retiree Medicare supplement plan. Please contact the Fund Office for your retiree options for continuing health coverage.

Supplemental Plans A & B Summary Plan Description
Non-Supplemental Plans A & B Summary Plan Description
Doorstaff Summary Plan Description

Death

In the event of your death, your dependents may continue coverage for up to 36 months by electing COBRA continuation coverage or by electing the retiree plan or the Medicare supplemental plan for surviving spouses and dependents. Your survivors will need to make the required self-contributions for this coverage.

SERVICE PROVIDERS

PPO, Network Providers and Dental Benefits
Click here to visit Visit BCBSIL.com for information on PPO, Network Providers and Dental Benefits.

Prescription Drug and Specialty Pharmacy Benefits
Click here to visit Visit caremark.com for information on Prescription Drug and Specialty Pharmacy Benefits.

Vision Benefits
Click here to visit Visit eyemed.com for information on Vision Benefits.

Employee Assistance Program
Click here to visit Visit ers-eap.com for information on the Employee Assistance Program.

Delta Dental of Illinois
Click here to visit Visit the Delta Dental of Illinois Website.

Delta Dental Mobile App
Click here for more information about the Delta Dental Mobile App.

WEBSITE DISCLAIMER

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