Frequently Asked Questions

Health & Welfare

Q.  Who are my eligible dependents?

A. Your lawful spouse;

    Your biological children up to age 26;

    Your legally adopted children up to age 26;

    Your step-children up to age 26; and

    Child for whom you have been appointed legal guardian by court for length of guardianship or to age 26, which occurs first

 

Q. When do I become eligible for benefits?  

A. You will become initially eligible for benefits on the 1st day of the month after you have accumulated contributions paid by your employer of 400 or more employment hours during a 5 consecutive month period.

Q. How do I maintain my continued health care coverage?   

A. Once you have passed initial eligibility, to maintain your coverage, you must work at least 100 hours per month.  If you do not work 100 hours per month but have sufficient hours in your hour bank to make up the difference, your coverage will be continued.

Q. I worked over the amount of hours needed for coverage, what happens to those additional hours?

A. For any hours you work over 100 in a month, those exceeded hours are placed into your "hour bank", the maximum amount of exceeded hours allowed to be placed in the hour bank is 1,000 hours (10 months of coverage). You may utilize hours in your hour bank to assist you in maintaining coverage (i.e. You only worked 60 hours in a month, so you will be short by 40 hours for coverage but your hour bank has a balance of 200 hours. The Fund will withdrawal 40 hours from your bank and add those hours to the 60 hours you work to ensure you have continued coverage. After the withdrawal, your hour bank balance will be 160 hours).

 

Q. How do I add my new baby or spouse to my insurance plan?

A. You must submit a completed, signed Enrollment & Vital Information Form along with other required legal documentation to the Benefit office. You can download the Enrollment & Vital Information Form located under Health Care Document section on this website and mail it into the Benefit Fund Office. You must enroll your new dependent within 30 days of birth, adoption, marriage or other important life changes.
 

Documents Required Are:   (you must provide these documents or your dependent will not be covered)
Spouse: copy of your marriage certificate, copy of spouse's photo ID, copy of spouse's Social Security Card
Child: copy of your child’s birth certificate, copy of child's Social Security Card, copy of child's photo ID (if applicable)
Step-child: copy of child’s birth certificate, copy of child's Social Security Card, copy of child's photo ID (if applicable)
Adopted child: copy of legal decree of adoption, copy of child's Social Security Card, copy of child's photo ID (if applicable)
Child for whom you have been appointed their legal guardian: original copy of legal guardianship documents, copy of child's Social Security Card, copy of child's photo ID (if applicable)    If Temporary guardianship, status updates will be required every 6 months

 

Failure to remit the required enrollment & vital information form and documents will delay your dependent from getting on coverage.

 

Q. How do I add my spouse to my healthcare benefit?

A. Please contact the Benefit Office at (754) 777-7735 for more information. You may also download an Enrollment & Vital Information form located under Health Care Documents section on this website. Once downloaded, complete the enrollment & vital information form in its entirety and submit a copy of your marriage certificate, a copy of spouse's photo ID and copy of spouse's Social Security Card. Failure to remit the required enrollment & vital information form and documents will delay your spouse from getting on coverage.

 

Q. How do I add my newborn child to my healthcare benefit?

A. Please contact the Benefit Office at (754) 777-7735 for more information. You may also download an Enrollment & Vital Information form located under Health Care Documents section on this website. Once downloaded, complete the enrollment & vital information form in its entirety and submit a copy of your newborn child’s birth certificate and copy of child's Social Security Card when available. You must enroll your newborn child within 30 days of birth. Failure to remit the required enrollment & vital information form and documents will delay your newborn child from getting on coverage.

 

Q. Whom should I contact if I'm getting a divorced and what documents do I need to submit?

A. Please call the Benefit Office and advise the Eligibility and Pension Departments that you are getting a divorce or have already gotten divorced. You will also need to submit a FULL copy of your Judgment of Divorce, Marital Assets/Property Agreements and orders or decrees to the Benefit Office. You should request a new beneficiary form.

Q. I am a first year Apprentice, do I get health coverage?  

A. No health coverage is not available for first year apprentices. When you advance to a second year apprentice, you will be come eligible for health coverage after 1 hour of work as an Apprentice 2nd year is remitted on your behalf. Eligibility begins on the first day of the month following receipt of that 1 hour of work. 

Q. Whom should I call if I have questions about my eligibility?  

A. Please contact the Benefit Office at (754) 777-7735 

 

Q. What if I don’t have enough contributions or hour bank credits to gain eligibility for the month?

A. If you fail to have the required employer contributions or hour bank credits to continue healthcare coverage, you may continue coverage by electing COBRA. Each month, the Benefit Office will determine if you have enough hours or hour bank credits to continue eligibility. If you do not, you will receive a COBRA package in the mail explaining your rights under COBRA. It is important to read this package thoroughly so that you are aware of your rights and understand the steps for continuing coverage under COBRA.  

 

Q. Will my child(ren) who is/are age 19 through age 26 be covered under the Plan?

A. Yes. Due to the Healthcare Reform Act, dependent children are now eligible to remain on the coverage until the age of 26, regardless of student status. Please contact the Benefit Office at (754) 777-7735 for more information.

 

Q. How do I make a payment to continue my Health Care coverage?

A. You may remit monthly COBRA self-payments via personal check, money order or cashier’s check to MCASF Local 725 Health & Welfare Fund at 15800 Pines Blvd., Suite 201, Pembroke Pines, FL 33027. You may also pay through your PayPal account, the PayPal button is located on the Health page.

 

Q. How do I inquire about the status of my medical claim or request a new medical ID card?

A. Your medical claims are paid by Florida Blue. Should you have any questions on your medical benefits, claims status, please contact BCBSFL at (800) 664-5295. To request a new ID card, please contact Benefit Office at (754) 777-7735.

Q. Is there a deductible for the insurance?

A. Yes, In-Network; $500 per person/ $1,500 family. Out-of-Network; not applicable. Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must their own individual deductible until the total amount of deductible expenses paid by all family members meet the overall family deductible. The medical plan's benefit year is January 1st through December 31st.

Q. Is there a deductible or co-payment on office visits?

A. Yes, there is a $45.00 co-payment for a doctor's office visit. 

Q. Is there a charge for an Emergency Room visit?

A. Yes, there is a $300.00 deductible per visit. Urgent care cost is more lower, please check out this helpful flyer Know before you go - Urgent Care vs. Emergency Room to help you determine which facility you should received care. 

Q. I'm an Actively working member and I have illness that is preventing me from working, does the Fund offer any benefits?

A. Yes, if you become disabled due to illness or injury, you may qualify for short term disability if you meet the requirements. You may be entitled to a benefit based on your job classification if your injury or illness occurred off the job. Benefit for General Foreman, Foreman, R5, R1 & MESJ is $500.00 per week. R2 & Apprentice 5th Year is $360.00 per week. And for R3, R4, MES2, MES3, Apprentice 2nd Year , 3rd year & 4th Year and MAT it is $250.00 per week. A maximum benefit of 26 weeks. Please contact the Benefit Office at (754) 777-7735 for further information.

Q. I need a prescription, is there a co-payment? Where can I get my prescription filled?

A. Yes, the Fund has 3 levels of prescription co-payments, in addition, there is mail order available which will save you money if your prescription is for a longer period.

> Generic Drugs: $15 co-pay for retail and $30 co-pay for mail order

> Preferred Brand Drugs: $35 co-pay for retail and $70 co-pay for mail order 

> Non-Preferred Brand Drugs: $65 co-pay for retail and $130 co-pay for mail order

If you utilize an Out-of-Network Pharmacy, you will have a 50% co-insurance cost on your prescription.

> Specialty Drugs: Subject to the cost share based on applicable drug tier. Not covered through mail order.

 

Florida Blue is our pharmacy benefit manager, if you click on their website link on the Health Care page of this website, you will be able to find a Pharmacy near you or call (800) 664-5295.

Q. Is there any other benefits than the medical provided by the Fund, like dental?

A. Yes, the Fund offers Dental Coverage through Florida Combine Life, a Florida Blue company. Check the Health Documents page for information on Florida Blue Dental. To find an in-network dentist quickly and easily, visit  www.floridabluedental.com/find-a-dentist 

Q. Is there a maximum benefit for the dental plan?

A. Yes, the Plan Year maximum is $2,500 with coinsurance payable by Florida Blue Dental for covered services at 70%. You pay the remaining 30% of covered services. Orthodontia service for all insured with a lifetime maximum of $1,000. Dental plan year is August 1st  through July 31st. 

Q. Is there any life insurance provided by the Fund?

A. Yes, the Fund offers a self-funded Life Benefit and Accidental Death & Dismemberment benefit program for actively working members. There is no benefit available for your spouse or dependents nor if you are a retiree.