Zenith American Solutions

Frequently Asked Health Care Questions

Q. How do I get in touch with the Fund Office?

A. You can call the Fund Office at (402) 592-3753 or Toll Free 866-315-1739 or in person at:
8960 "L" Street Suite
101 Omaha, NE 68127-1414.
Office hours are Monday through Friday 8:00 a.m. - 4:30 p.m. Central Time.

Q. When do I first become eligible for coverage?

A. You become eligible for coverage on the first day of the second month following the month in which your credited hours of employment with one or more contributing employers total two hundred-eighty (280) hours or more, within a three (3) consecutive calendar month period or less. These first two hundred-eighty (280) hours will not be credited to your Hour Bank. After you have worked these two hundred-eighty (280) hours, the additional hours you work will be credited to your Hour Bank. Health & Welfare SPD

Q. How do I maintain my coverage?

A. Hours worked for Contributing Employers by a Bargaining Employee will be credited to the Bargaining Employee’s Hour Bank Account. One hundred forty (140) hours of reported credit will be deducted from the Bargaining Employee’s Hour Bank Account for each month of coverage. Whenever a Bargaining Employee is credited with more than one hundred forty (140) hours during a month (which is required to furnish one month’s coverage), the excess hours will be added to the Bargaining Employee’s Hour Bank accumulation. As of June 1, 2014, the maximum amount of hours an Employee can accumulate in his Hour Bank Account is 840 hours.

Q. Where can I obtain and submit a health plan enrollment form?

A. You may obtain an enrollment form by contacting the Fund Office at Toll-Free 866-315-1739 or printing a form from this website. Send the completed form to the Fund Office at 8960 “L” Street, Suite 101, Omaha, NE 68127-1414 at Toll-Free 866-315-1739. Please be sure to include a copy of your marriage certificate if you are adding a spouse and birth certificates for adding children.

Q. How do I know if I am eligible for health coverage this month?

A. Log in to your account to view your eligibility.

Q. I am moving. How should I provide my new address?

A. You can change your address by calling the benefits office at (402) 592-3753. By answering a couple security questions we can make the change over the phone.

Q. We just had a baby. How do I enroll my newborn in the health plan?

A. To enroll your newborn, complete the enrollment form and send the completed form to the: Fund Office 8960 “L” Street, Suite 101 Omaha, NE 68127-1414 Local: (402) 592-3753 Toll-free: 866-315-1739 Fax: 402.592.2352 Office Hours: Mon - Fri 8:00 a.m. – 4:30 p.m. Central Time Website: www.22benefits.com Coverage shall begin at birth for your newborn child so long as the Dependent child’s enrollment form was postmarked or otherwise positively received by the Fund Office within ninety (90) days of such birth. If the Dependent child’s enrollment form was not postmarked or otherwise positively received by the Fund Office on such date, the Dependent shall become eligible for coverage of claims incurred on or after the date the Dependent Child’s enrollment form is postmarked or otherwise positively received by the Fund Office.

Q. I’m getting married. How do I add my new spouse to my health coverage?

A. To enroll your new spouse, complete the enrollment form and send the completed form to the Fund Office at 8960 “L” Street, Suite 101, Omaha, NE 68127-1414. Please notify the Fund Office as soon as possible so that your records can be updated. You may also want to update your beneficiary designation forms for the Health Plan, Pension Plan A, and Defined Contribution Plan B.

Q. What do I do if I get a divorce?

A. You must notify the Fund Office immediately in the event of your divorce. Any benefit payments made by the Plan on behalf of an ineligible Dependent will be your responsibility. Failure to notify the Fund Office of divorce will be considered an omission that constitutes fraud and an intentional misrepresentation of a material fact that is prohibited by the terms of the Plan. If you do not notify the Fund office of your divorce, the Plan may recover any payments made for claims incurred by your former spouse after your divorce. See the following FAQ’s for information regarding how a divorce may also impact your benefits from the Pension Plan A and Defined Contribution Plan B.

Q. I lost my ID card. Where can I get a replacement ID card?

A. Call UMR's customer service center at 1-800-207-3172 to get a replacement medical ID card. Call CastiaRx (formerly LDI) for a replacement prescription ID card at (402) 592-3753 or 866-315-1739.

Q. What type of health coverage do I have?

A. Your medical coverage is through UMR. Health and Welfare SPD. Your prescription coverage is through CastiaRx (formerly LDI), and you have wellness benefits through SimplyWell www.simplywell.com.

Q. How much is my Health Plan deductible?

A. You have a calendar year deductible of $700 as an individual or $2,100 as a family. Please refer to the Summary Plan Description for a complete list of covered benefits.

Q. How do I find a doctor?

A. You can find an in-network doctor on the UMR website at www.umr.com by clicking “Find a Doctor” or by calling 866-315-1739.

Q. Where can I fill my prescription?

A. CastiaRx provides a network of participating retail pharmacies and the mail order pharmacy program. When you need a medication for a short time, for example, an antibiotic, you should fill your prescription at a retail pharmacy. You are not required to use a participating pharmacy; however, if you purchase your prescription at a non-participating retail pharmacy you will likely pay a higher amount for that prescription. To view a complete list of participating pharmacies visit the CastiaRx website.www.castiarx.com. When you need a medication to treat a chronic or long-term sickness or injury, for example, medication to control blood pressure or cholesterol, if you are an active member (not retired) it is mandatory to fill your prescription through the CastiaRx mail order. To enroll your prescription at the mail order pharmacy, you can call LDI at 866-516-3121 or visit the CastiaRx website at www.castiarx.com. Claims forms are available at the CastiaRx website www.castiarx.com.

Q. Will I have health benefits when I retire?

A. You may be eligible for retiree coverage. Please contact the Fund Office for more information.

Q. How far back can I submit claims for reimbursement?

A. Claims must be received by the Fund Office by June 30 of the calendar year following the calendar year in which the expense was incurred.

Q. Where can I find the Accident and Sickness form?

A. You can obtain a claim form by going to the documents tab or you can call the Fund Office at (402) 592-3753 or Toll Free at 866-315-1739.

Q. When will my Accident and Sickness begin?

A. If you are totally disabled due to an accidental bodily injury or sickness, and under the care of a M.D. or D.O., benefits begin the first day if the disability is caused by an accident and on the eight day if due to sickness.

Q. Is there a benefit maximum?

A. Yes, the Accident and Sickness benefits are payable for a maximum of twenty-six weeks.

Q. What is an HRA and how does it work?

A. An HRA is an employer-funded arrangement that provides tax-free reimbursement to eligible Active and Retired Employees for certain medical expenses incurred by you or your eligible dependents. Amounts that are not used in one year can be carried over to the following year, provided you remain an eligible Active or Retired Employee. You will not be taxed on the value of your HRA or on the reimbursements you receive from your HRA.

Q. What are the eligible expenses under an HRA?

A. The funds in your HRA can be used for allowable health care expenses. In general, any medical or dental expense that is not reimbursed or reimbursable by a health or insurance plan, and that you haven’t claimed the expense as a deductible on your federal tax return such as health plan premiums, co-payments, deductibles, co-insurance. For a complete list of eligible expenses, please see the Health and Welfare SPD. It's important to note that your Benny debit card will ONLY work for prescription co-payments.

Q. How do I receive reimbursement?

A. There are a few ways to receive your reimbursement: Benny prepaid VISA benefits card! Your debit card can be used for prescription benefits only. Each participant receives two Benny prepaid VISA benefit cards. Just swipe the card for an amount up to your available account balance. Sign up for direct deposit and receive reimbursements right into your bank account! Sign up for automatic recurring reimbursement of your premiums! At the beginning of each year, provide documentation of your monthly insurance premium and you will automatically be reimbursed each month via check or direct deposit (for amounts up to your account balance). Receive a check in the mail after filing a claim. Submit your claims... Use our app on your smart phone. You can take a photo of your receipts and upload your claim! Mail a claim form to the Fund Office. Obtain a claim form here, or you can contact the Fund Office and one can be mailed to you.

Q. How far back can I submit claims for reimbursement?

A. Claims must be received by the Fund Office by March 31 of the calendar year following the calendar year in which the expense was incurred.