FREQUENTLY ASKED QUESTIONS
Eligibility
How many hours do I need to work to become eligible for insurance?
You need 400 hours in four consecutive months. Coverage begins the first day of the month following meeting eligiblilty requirements.
How many hours do I need to work to be reinstated?
You need 150 hours in three consecutive months. Coverage begins the first day of the month following meeting eligiblilty requirements.
Up to what age are my dependents covered?
Dependents are covered until the last day of the month they turn 26 years old.
If I get married, what day is my spouse covered?
A member's legal spouse will be considered a dependent from the date of marriage or the date of member's eligibility, whichever is later.
How do I request an additional/replacement dental card?
How do I request an additional/replacement medical and prescription identification card?
Contact the eligibility department at the Fund Office.
How do I add a new family member to the plan?
Contact the eligibility department at the Fund Office. If applicable, you will be required to submit a birth certificate, marriage license and social security card for any new dependents.
Claims
Do I have a deductible?
Yes. There is an annual deductible that applies to select services.
What services does my deductible apply to?
Your deductible applies to emergency room visits, inpatient hospital stays, outpatient surgery and services, home health care, and most services rendered by non-network providers. There is a seperate annual deductible for DME (Durable Medical Equipment).
How do I find a doctor who is in-network?
Go to www.cmrnetwork.com or call the Benefit Office at 314-652-8175 and ask for assistance.
What does it mean to use an in-network provider?
Members of SMART Local 36 Welfare Fund have access to discounted rates from CMR network providers. By utilizing a CMR network provider, you will receive the highest level of benefits at a lesser cost for both you and the Fund.
What lab should I use?
Quest or LabCorp are two commonly used laboratory facilities in the CMR network. Go to www.cmrnetwork.com for a complete list of providers.
What is the most I will have to pay out of pocket for eligible medical expenses?
In 2017, the maximum out-of-pocket is $4,000 for an individual and $8,000 for a family for services provided by CMR network providers.
What are the Chiropractic benefits?
The chiropractic benefit has a limit of 26 visits per year with a $25 copayment per visit. Additional services provided, such as x-rays, will be subject to a 20% coinsurance. There is no benefit available for services provided by non-network chiropractors.
What does EOB mean?
Every time the SMART Local 36 Claims Department processes a claim submitted by your provider or you, we explain how we processed it in the form of an explanation of benefits (EOB). The EOB is not a bill. It simply explains how your benefits were applied to that particular claim. It includes the date you received said service, amount billed, amount covered, amount we paid and any balance you're responsible for paying the provider. Each time you receive an EOB, review it closely and compare it to the receipt or statement from your provider.
Who can I go to for vision care?
You are not limited to CMR network providers and have vision benefits at any provider. However, if you see a CMR provider it may cost you less out of pocket.
When does our deductible start over?
The deductible starts over each year on January 1st.
Why is it important to fill out and return your PHI form?
The PHI form authorizes only the specified person(s) that you have listed to be able to receive any information about your private helath information.
How much does the Plan reimburse for vision benefits?
Vision benefits are limited to up to $60 for one exam per year, up to $150 for one pair of frames and a maximum of $60-$100 for lenses per year, and up to $170 for contact lenses per year. Benefits are avaialble for either frames and lenses or contact lenses once per year, not both.
