D.A. Townley  -  Plan Administrators Iron Workers Union Local 97 International Association of Bridge, Structural, Ornamental and Reinforcing Iron Workers 
 

health
benefits

        
 
 
 
 
 
 
 
 
 
 
 
 
   
   
   
 
 
 
 
   
 
 
 
 
 
   
 

Health Benefit FAQs

The following are the most commonly asked questions by Members regarding the Health & Welfare Plan. If you would like detailed information on any of these topics, please consult the Health & Welfare Plan Booklet. If you still have questions after reading this information, please contact the Plan Administrator.


How can I tell if I'm covered by the Plan?
To ensure that you are indeed covered at the time you incurred or will incur a claim, and to ensure that your employer has submitted the appropriate hours to the Plan on your behalf, you will need to contact the Plan Administrator. Individual Member records are not available on this web site. The Health & Welfare Plan Booklet describes how you qualify and maintain coverage. (Please refer to Part I of the Health & Welfare Plan Booklet.)

What if I become unemployed?
The Plan includes a provision of six months of self-payment for a Member who was covered under the Local 97 Ironworkers Health & Welfare Plan. Please refer to Part I of the Health & Welfare Plan Booklet.

When does my coverage end?
Coverage is always provided on a whole-month basis only and will be terminated when:

  1. Your Hour Bank falls below 110 hours and you fail to make a payment by the date specified on the self-payment notice (Members ONLY) to bring your Hour Bank up to the required hours; or,
  2. You have already make 6 consecutive self-payments to the Fund.
The Health & Welfare Plan Booklet describes extended coverage on termination and the Self-Pay Plan. Individual Member records are not available on this web site. To check your individual coverage, you will need to contact the Plan Administrator.

Who is eligible as a dependent?
Dependents eligible for benefits are:

The Spouse of an Insured Person, and unmarried dependent children to age 21, unless the dependent child is attending a recognized school, college or university on a full-time basis, in which case the maximum age will be 25. A child is not a dependent if he/she is eligible for or entitled to benefits under this Plan as a Member.

What is my Vision Care benefit?
The maximum amount payable during any period of 24 consecutive months shall be 90% of the actual expense incurred or $500.00 whichever is the lesser for an eligible adult. A maximum amount of $300.00 payable during any period of 12 months for an eligible dependent to age 19.

Please refer to the Vision Care section, under Part IX of the Health & Welfare Plan Booklet. Please be sure to read the entire section, including the Exclusions that are listed.

When did I last get glasses - am I eligible for another pair?
Individual Member records are not available on this web site. Please contact the Plan Administrator.

What is co-ordination of benefits?
If a Member or any eligible Dependents are entitled to receive similar benefits simultaneously under the Health Benefit Plan or any other group insurance plan (including Provincial Plans), to prevent over payment, benefits payable under this Plan would be co-ordinated with the other Plan.

For example: A Member’s wife is covered under her employer’s plan with family coverage. The Member, his spouse and their three children are all covered under both Plans. The responsibility of the initial reimbursement is determined as follows: Between the Member and the spouse, whoever’s birthday falls first in the calendar year, their plan is responsible for the initial payment of benefits for the dependent children, then, any amounts that are not paid by that Plan are submitted to the other spouse’s plan.

Therefore, in the event that the Member’s birthday is in April and the spouse’s birthday is in January. The spouse’s plan would be primarily responsible for her claims and the claims of the children. Any amounts not paid by her plan can be submitted to the Member’s Plan for reimbursement.

Please see Part I of the Health & Welfare Plan Booklet.



 
 
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