Health Reimbursement Account

Quick Reference

Website
Call Zenith American Solutions: 800-446-8646
Customer Service hours: 8 a.m. – 4 p.m., M – F

Account Highlights

Participation

• A Health Reimbursement Account is established in your name automatically when you are enrolled in the Fund’s Medical Plan
• Medical Plan enrollment for you and your eligible dependents is automatic if you meet the Fund’s eligibility requirements

Contributions

• Your employer makes contributions to your HRA on your behalf; you do not and cannot contribute to your HRA
• As your employer’s contributions for your cost of health care coverage are received each month, they will first be added to the Administrative Account to accumulate to the required amount of $4,050—to maintain health plan eligibility for you for each calendar quarter
• Once employer contributions are accumulated for you to maintain coverage for the next calendar quarter, amounts over $4,050 will be moved to your HRA automatically
• Essentially, at the beginning of any calendar quarter, before deducting money to maintain your health benefits eligibility, your Administrative Account balance is at least $8,100
• If, on the last business day of a calendar quarter, your Administrative Account is less than $8,100 for the upcoming two coverage periods, money in your HRA will be moved back to your Administrative Account.
  • This will bring your Administrative Account up to the required $8,100 needed for the coming two coverage periods
  • Any amount above $8,100 will stay in your HRA
• If employer contributions are not made to your HRA for 24 consecutive months, your HRA balance will be forfeited

Using Your Account

• Use money in your HRA to pay eligible health care expenses you have from January 1 through December 31 of each year, including medical, dental, vision and hearing costs that are not covered—or are only partially covered—by your health plans, including deductibles, copayments and coinsurance
• See IRS Publication 502 for a list of eligible expenses
• Submit claims by March 31 of the following year for expenses you have during the current plan year

Required Claim Documentation

• Insurance company statement or Explanation of Benefits (EOB)
• Itemized bill from your provider showing date of service, services provided, service provider, amount paid and, if applicable, amount covered by insurance

Details

Anthem Blue Cross Blue Shield Preferred Provider Organization (PPO) Plan

Quick Reference

Website
Call Anthem Blue Cross Blue Shield customer service: 800-810-2583
Find a provider

Coverage Highlights

• You choose a Primary Care Physician (PCP) for in-network care
• Your PCP coordinates all care through Anthem providers and facilities
• Your PCP also refers you to in-network specialists or hospitals, when necessary
• Care from in-network providers cost you less because in-network providers discount their fees and can’t balance bill you

Details

• If you opt out of Plan coverage (including providing the Fund Office with evidence you are covered under an employer group comprehensive medical benefits plan through your spouse’s employment), $1,050 will be deducted quarterly from your Administrative Account
• The $1,050 deduction is for Life Insurance, AD&D Insurance and Weekly Disability benefits provided the Fund, plus an appropriate share of administrative expenses for the calendar quarter
• If you opt out of coverage and have less than $1,050 in your Administrative Account, $350 will be withdrawn from your Account monthly
• To re-enroll for coverage if you opt out, you must have a qualifying life event (e.g., marriage, divorce, birth or adoption of a child, loss of other health care coverage)

Anthem Blue Cross Blue Shield PPO Summary of Benefits and Coverage (SBC)

Heat and Frost Insulators Local No. 33 Health Fund SPD

Utilization Review Program

Quick Reference

Hines & Associates customer service: 800-944-9401
Available 24/7/365

Program Highlights

• The following must be reviewed by the Plan (through Hines & Associates) before you or your eligible dependents receive care: any scheduled non-emergency hospitalization; inpatient or outpatient surgery; inpatient mental health treatment; inpatient alcohol or substance use disorder treatment; home health care; hospice care
• If you don’t receive utilization review, you will pay a penalty
• Hines & Associates administers our Utilization Review Program
• The Utilization Review Program works with you and your doctor to keep medical care costs as low as possible, consistent with accepted medical care standards
• Review of the need for applicable care, and exploration of available alternatives, may show that certain kinds of treatment may be avoided and alternative, equally-effective treatment may be available
• This Program exists to help you use alternative care and treatment effectively so you can avoid the inconvenience of a hospital stay, or spend some of your time recovering in a more comfortable setting, such as at home

Details