General Health Plan

ANSWER: An HMO is an organization that provides health care to a voluntarily enrolled group at a predetermined price. An HMO uses a group of doctors and other health care professionals also known as "network providers." The HMO services are prepaid and there is no annual deductible. Participants do share costs, however, by paying a fee called a co-payment at the time services are rendered.

In the Indemnity Plan, physicians and facilities are reimbursed on a fee-for-service basis. The trust is billed for the services and paid in accordance with the rules adopted by the Board of Trustees. The patient is then billed for any balances including deductibles and unpaid percentages.

ANSWER: Although the indemnity plan medical benefits, including prescription drug benefits, are self-funded, mental health and substance abuse benefits are provided under an insurance arrangement with PacifiCare Behavioral Health (PBH).

ANSWER: You will become eligible on the first day of the second month following the date you accumulate 300 hours within a continuous twelve-month period. The EISB office will provide you with information concerning the Plan after you accumulate 125 hours.

ANSWER: You will be required to complete an enrollment card and provide copies of your birth certificate, marriage certificate or registration of domestic partnership, birth certificates of your dependents.

ANSWER: Generally yes in order to avoid confusion and disruption in coverage. However, the Plan Office will only use your number as necessary to ensure that the various providers properly credit your eligibility. As a part of EISB's security measures, all electronic information is encrypted and transmitted in a secure environment. Staff employees have been instructed to either shred or secure any documents that contain personal information in a locked drawer, including Social Security Numbers. If you participate in the Indemnity Plan, your physician only needs to use the last four digits of your number for identification purpose.

ANSWER: Prior to work in November, 2006 for coverage in January, 2007 you needed a minimum of 125 hours to sustain eligibility. Beginning with work in November, 2006 for coverage in January, 2007, you need 120 hours. The hours can come from 1) contributions made on your behalf by a contributing employer or 2) from your hour bank reserve account. Eligibility is provided on a skipped month basis with hours worked in one month being applied to the second following month. For instance, January hours will apply to March coverage.

ANSWER: The reserve account system includes a separate record for each active member and includes hours that were not already used to provide eligibility, up to a maximum of 1,000 hours. For instance, if you work 130 hours in November, 2006 or later, 120 hours will be used to provide eligibility and the remaining 10 hours will be added to your hour bank reserve account. Prior to November, 2006, 125 hours were required.

ANSWER: The contributions on hours in excess of the maximum are not credited to individuals but remain in the pooled assets that are used to cover the costs of providing benefits and administration of the Plan.

ANSWER: If you do not have sufficient hours, you must pay the full direct or COBRA payment required under the Plan. You may not make up the difference. The only exception to this rule is that day school apprentices who are in good standing and whose loss of eligibility is solely attributed to attending day school may make up the difference.

ANSWER: You may call the Plan Office at any time if you wish to know how many hours you have in reserve. You will also receive notices shortly before your hour bank reserve account runs out that includes information on Regular Direct Payments and COBRA (self-payment) continuation rights.

ANSWER: Your employer is required to pay the rate set forth in the collective bargaining agreement. Currently, the rate is $9.83 per hour for the majority of employers that contribute to this Plan, although different rates apply to the Motor Shop Agreement and the San Francisco Housing Agreement. Of the total contribution, $9.70 is for the Health Benefits and $0.13 is for Long Term Disability benefits.

ANSWER: No, this is would lead to selection against the Plan by allowing individuals to use their hour banks only when they need the coverage.

ANSWER: It is a multiemployer welfare benefit plan [that is jointly managed by union representatives and representatives of the employers. The trust, rather than each participating employer, provides and manages your group health care and certain other welfare benefits. Each employer contributes on a cents-per-hour basis the amount specified in the collective bargaining agreements on behalf of each of their "covered employees." These contributions are held in the Plan's trust for the purpose of providing health care and other benefits to plan participants and their eligible dependents.

ANSWER: The Plan's Board of Trustees consist of three trustees selected by IBEW Local 6 and three trustees selected by the San Francisco Electrical Contractors Association, with each entity also selecting an alternate trustee who attends all meetings but takes action only when a regular Trustee is not available. Your Trustees invest the Plan's assets, interpret and amend the Plan, decide policy questions, and contract with various advisers who render advice and/or perform services for the administration of the Plan. This includes an accountant, legal counsel, an investment manager, plan manager and plan consultants.

ANSWER: The trust provides a self-funded indemnity plan, and two HMO options--- Kaiser and PacifiCare. Some families prefer the convenience of the HMO arrangement because the co-payments are made at the time of treatment and there are no subsequent billings to worry about. Others prefer the more traditional indemnity plan arrangement because they are not limited to an established network of doctors or facilities and are not confined to treatment within any designated service area or facility.