FAQs

Our Insurance Providers

Health Insurance 101

  • Copayment: A fixed amount you pay for a covered service (e.g., $20 for a doctor visit).
  • Deductible: The amount you pay out-of-pocket for covered services before your insurance starts to pay.
  • Coinsurance: The percentage of costs you share with your insurance after meeting your deductible (e.g., you pay 20%, insurance pays 80%).

Not always. Your copayment typically covers the office visit itself, but additional services—such as lab tests, imaging, or procedures—may be billed separately and could apply to your deductible or coinsurance, depending on your insurance plan.

If a provider accepts insurance, they will bill your insurance company for services, but they may not have a contract with your insurer. This means they could be out-of-network, and you might pay higher costs.
If a provider is in-network (or participating), they have an agreement with your insurance company to accept negotiated rates. This usually means lower out-of-pocket costs and more predictable coverage for you.

No. The plans we offer do not require you to select a primary care physician or obtain referrals to see specialists. You can schedule appointments directly with any in-network provider.

No. Our dental benefit does not issue separate ID cards. The plan is through the Teamsters Health and Welfare Fund, and members should use the ID number on their medical card for dental services. Do not give the dental office your medical card, simply provide the ID number. You may also use your Social Security Number if you prefer.

Coordination of benefits

Employment and coverage can change, so we update your information annually to ensure claims are paid correctly. Incorrect or outdated details may lead to claim recovery. Keeping this information current is especially important for spouses who have access to coverage through their employer.

Our plan requires members to use their auto insurance as the primary coverage for injuries sustained in a motor vehicle accident. This includes situations where you are a pedestrian or riding a bicycle and are injured by an automobile. We will not pay as primary in these cases, so members should make this clear to their auto insurance carrier.

If your claim may be related to an accident or injury caused by a third party, that party is primarily responsible for your medical expenses. The questionnaire helps the Fund determine who is responsible for payment. Unfortunately, claim details alone don’t always provide the full picture and do not include medical records, so we need additional information from you. This process prevents incorrect payments and helps control premium costs.

No. If your spouse works 32 hours or more per week and is offered health coverage through their employer, they must enroll in that coverage as their primary insurance. They cannot waive those benefits and rely solely on the Fund’s coverage. The only exception is if your spouse is required to pay 100% of the premium for their employer’s plan.
For more details, please contact the Fund’s Census Department at 800-523-2846 option 1.

Qualifying Life Events

You can update coverage for a spouse or dependent within 30 days of a qualifying life event. Life events include marriage, divorce, birth or adoption of a child, or loss of other coverage.

To add a newborn, you must notify the Fund Office as soon as possible after birth. Newborns can be covered for the first 30 days of life without a birth certificate, but you will need to provide the birth certificate to continue coverage beyond that period. You’ll also need to complete the required enrollment forms within 30 days of the birth. Please see the Summary Plan Description (SPD) for details on who is considered an eligible dependent.

Contact Member Services at 800-523-2846 (option 1) for instructions and to request the necessary forms.

It is critical to inform the Fund Office as soon as possible after a divorce. Failure to do so may result in claims being paid for an ineligible spouse, creating an overpayment. Any overpayments made will be the member’s responsibility to reimburse to the Fund. Prompt notification helps avoid unnecessary costs and ensures your coverage remains accurate.

Visit the Pension page to learn more.

COBRA

Your coverage termination date depends on the employer you worked for and your personal work history. You may be eligible for up to two months of coverage after leaving employment. To confirm your exact termination date, please contact Member Services at 800-523-2846 (option 1).

COBRA (Consolidated Omnibus Budget Reconciliation Act) is a federal law that allows you to continue your employer-sponsored health insurance for a limited time after losing coverage due to job loss, reduced hours, or certain other life events by paying a monthly premium.

COBRA continuation coverage rates are reviewed annually and may change each year. Your rate depends on the coverage you elect—such as Member Only, Family, Member/Child, or Member/Spouse—and whether you include Vision and Dental or choose Medical and Prescription only. For details, contact the Health and Welfare Office at 800-523-2846 (option 1, then option 3).

short-term disability

If you qualify for STD, you may receive a weekly benefit for up to 26 weeks through your Health & Welfare benefits. The amount is a set rate based on your employer, not your wages. Payments are mailed weekly (typically on Fridays); direct deposit is not available.
To start benefits, you must complete a disability application, which can be downloaded online or requested by calling the Fund Office at 800-523-2846 (option 1). Claims cannot be processed unless all sections are completed.

Please notify the Fund Office immediately when you return to work to avoid overpayment.

We periodically require a Continuance of Disability form completed by you and your physician to confirm you are still unable to return to work. When you receive this form with your check, you must have it completed and returned to us as soon as possible. We cannot issue another payment until the form is received and processed.