$30 copayment for preferred brand-name drugs; $45 copayment for non-preferred brand name drugs. A contributing employer is any employer that is obligated or permitted to contribute to the Fund. EnvisionRxOptions administers the Plans prescription drug benefits. We are having trouble matching the information you entered during registration to our database. Phone: (303) 623-5386 From Canada or U.S. (toll free): 1-866-870-1898. Due to the COVID-19 outbreak and in the interest of keeping the community and our staff as safe and healthy as possible, all WPAS offices (Mercer Island, Gladstone, Anchorage, Spokane) will be closed for walk-in services effective March 17, 2020. This number is pre-printed on the form. 501 W. 42nd St. Continue. Welcome to the new Southeastern Iron Workers Web Site. hbbd``b`m H Y To learn more about dental services listed above please refer to the HEALTH BENEFIT PLAN BOOKLET. You should contact Iron Clad Insurance at 617-436-3500 with questions on medical and dental claims, prescription benefits and dependent eligibility. The expenses must have been incurred by you or one of the eligible dependents currently on file with the Plan Administrator. The Northwest Ironworkers Trust Funds were established to provide health, retirement and annuity benefits for eligible members and dependents through the collective bargaining process with the Iron Workers District Council of the Pacific Northwest comprised of Local Union No. You should contact the Iron Workers Fund office at 617-265-3757 with questions on member eligibility, vision benefits, disability benefits and life insurance. Type. iv Iron Workers District Council of New England Health Benefit Plans Important Contact Information Fund Office Iron Workers District Council of New England Health and Welfare Fund 161 Granite Avenue Dorchester, MA 02124 617-265-3757 or 800-637-3736 Claims Office Iron Clad Insurance 161 Granite Avenue, Suite 201 Dorchester, MA 02124 617-436-3500 . (425) 454-3003, or toll free 1 (800) 648-5834 Shop 509; Information & forms; Contact Shop 509 . Phone: (316) 264-2424, Copy right 2014 impact.com. Your fully completed claim form and receipts can be emailed tohealth@datownley.comor faxed to (604) 299-8136 or mailed/dropped off to thePlan Administrator. VISIT US. Iron Workers - Local 764 Iron Workers Education and Training Centre Local 764 Iron Workers Local 752 NB Ironworkers Local 842 Iron Workers Local 786 Ironworkers - Local 700 Ironworkers - Local 721 Ironworkers - Local 736 Ironworkers - Local 765 Ironworkers - Local 786 Ironworkers Local 759 Ironworkers Local 765 Maidstone Training Centre . Ontario Ironworkers Pension & Benefit Plan Building on Our Strengths A solid foundation - it's what ironwork is all about. 501 W. 4th Ave Denver, CO . In addition the Administrator provides for the adjudication and payment of pension benefits. NOTE: Dependents age 13 and older need to complete a Dependent PIN Request Form for online access. Premera In-Network provider negotiated rates click here. Your dentist must completePart 1 of the form. Part 3 also collects information about other Benefit or Insurance Plans that you may be eligible to co-ordinate a claim from. Location. Part 2 is where your Member information is filled in, including your Plan policy number, 70682. This number is pre-printed on the form. IRONWORKERS LOCAL UNION NO. We are excited to bring you many new features on this . Organization. Unlike national competitors, Northwest Dental Benefits is transforming the industry with direct care, seamless claim management, and superior benefits. the denture being replaced is an immediate temporary denture installed within the past twelve months and is now being replaced by a permanent denture; Repairing, recementing or relining of dentures, crowns, inlays or bridgework; and. %PDF-1.6 % Information Needed to Complete the Form. 1330 E. 1st Street Wichita, KS 67214 This web site provides details of Benefit Plans, but is not a legal document. PO Box 34464 If your Eligible Dependent reaches his or her 26th birthday, and is in the process of a course of orthodontic treatment which began before he or she reached his or her 25th birthday, benefits for the course of orthodontic treatment will be payable under the following conditions: Disability Income Benefits: Authorization for Release of Protected Health Information, Anthem SBC for Non-Compliant HEP Participants, Anthem SBC for Compliant HEP Participants, Extended Benefit Fund Summary Plan Description, Over-the-Counter COVID-19 Test Information, 162 West Street, Building 2, Suite J | Cromwell, CT 06416-4404 | 203.238.1204 | 1.800.982.3709, Iron Workers LocalsNo. building a better world, your pension and benefit plans are at work making sure . 842 BENEFIT PLAN (MAJOR MEDICAL AND DENTAL) AND PENSION PLAN. Endodontic treatment, which includes root canal therapy; Anesthesia in connection with any Basic or Major Restorative Service; and. IRONWORKERS LOCAL 433. The spouses plan would be primarily responsible for the spouses claims and the claims of the children. The Active Plan covers 100% of Preventive Services, including: The Active Plan covers 80% of Basic Restorative Services, including: The Active Plan covers 50% of Major Restorative Services, including: The Basic Restorative Services and Major Restorative Services discussed above are subject to a deductible of $100 per individual or $300 per family per calendar year. Street Address for Claims, Eligibility, and Pension. You should identify yourself as an Iron Workers District Council of New England Welfare Fund member and the providers office will verify your eligibility for services. Basic and Major Services combined have an annual maximum of $2,700. The Plan provides coverage for prescription medication that you purchase from a retail pharmacy. These Funds have been established with the specific purpose of providing health care and a better way of life for the members of Local 580. The links below are intended to meet the compliance requirements for the Transparency in Coverage Act. 8123 0 obj <>stream Get your flu shot at an Albertsons, City Market, King Soopers or Safeway pharmacy, and the pharmacy will submit a claim for you. THE IRONWORKERS LOCAL 764 BENEFIT TRUST FUND GROUP DENTAL CLAIM FORM . Please see the General Information section for a description of Coordination of Benefits. Corporation, Out-of-Province Emergency Travel Insurance, https://travel.gc.ca/travelling/advisories, earned at least 35% of the Year's Maximum Pensionable Earnings under the Canada Pension Plan, covered under your provincial government health plan. you and your family have the support you need to build a better life. Northwest Dental Benefits (NWDB), founded by Avondale Dental Group, became the first dental insurance company established in Idaho in over 40 years. In network providers: A $20 copayment per visit will apply, then the visit is paid at 100% of the PPO rate, no deductible applies. 501 W. 4th Ave Denver, CO 80223 We encourage you to visit https://travel.gc.ca/travelling/advisories regularly for the most up-to-date travel information from the Government of Canada. Box 34203 endstream endobj startxref See Bank hours for more information. Welcome! The Dental Plan will cover you and your eligible dependents. The Plan pays a $250 weekly disability benefit if you become totally disabled due to an illness or a non-work related injury and are unable to work while you are covered by this Plan up to a maximum of 26 week for any one continuous period. The Long Term Disability plan is administered by Standard Insurance Company, please contact the Fund Office for an application and eligibility questions. Administered by Welfare & Pension Administration Service, Inc. 2023 Welfare & Pension Administration Service, Inc. Life Insurance benefits are covered for active member coverage only. Copyright 2000-2020 D.A. Electrical Workers' Insurance Fund. Please enable javascript to view this Any amounts for the Member that are not paid by the Members Plan can be submitted to the spouses plan for reimbursement. Welfare & Pension Administration Service, Inc. ), Transparency in Coverage Machine Readable Files. Should you choose to use a non-participating provider you must pay for services in full and file your own claim form with Davis Vision. Our Location Local 40 Hall located at: 451 Park Ave South New York, NY 10016 Cick on map for more detail. 8113 0 obj <>/Filter/FlateDecode/ID[<18AC60D35EC7BA4D9B42F4763FF4561F><0B6C6D48C1E48243964B2E99E6478DC4>]/Index[8105 19]/Info 8104 0 R/Length 59/Prev 984943/Root 8106 0 R/Size 8124/Type/XRef/W[1 2 1]>>stream Per that legislation, these files are designed to be read by machines. O-,Fb~ L: Part 3 also collects information about other Benefit or Insurance Plans that you may be eligible to co-ordinate a . Jan 24, 2022 admin. Hearing Aid Benefits (For Active Members), Iron Workers Locals No. 15and424 Benefit Funds. The month of June is a waiting period. professionals, any medical or dental facility, any insurance company or government body, and any other person or institutions to release relevant information to the Plan Administrator solely for the purpose of processing this claim. Part 3 is for patient information whether that is yourself, your spouse, or one of your dependant children. Your eligibility for benefits from this Plan is determined twice a yearon February 1 and August 1. In 1993 the Administrator moved to its present location at 111 Sheppard Avenue East, North York, Ontario M2N 6S2. The Active Plan covers orthodontic treatment (including correction of malocclusion) up to a lifetime maximum per individual of $2,500. Contact: Fully Effective Employees Please refer to the SPD below or the copy supplied to you by the Fund Office for additional information on your Health & Welfare benefits. So, while you're out there Eligible expenses are listed in the Dental section. If you need more information regarding this feature of the Plan, please ask the Administrator. When you are eligible, you will be notified by the Trust Fund Administrator, Compusys of Utah. This site provides general benefit information, forms and other Trust related items. The Administrator of these Funds can be reached at the following address: Local 580 Fund Office. You can now book in-person appointments online at our Mercer Island Office! 17495 Hurley St, City of Industry, CA 91744, United States Present your pay-direct card to your dental office receptionist when you arrive for your appointment. Completed forms should be forwarded to the Plan Administrator. California Ironworkers Field Defined Contribution Pension Trust Fund; About; Forms; Plan Documents; Shop 509 . Very important changes to your emergency travel insurance. So, while you're out there building a better world, your pension and benefit plans are at work making sure you and your family have the support you need to build a better life. The Active Plan covers 100% of Preventive Services, including: Dental examinations, scaling and cleaning of teeth or gums, up to twice in a calendar year; Part 2 is where your Member information is filled in, including your Plan policy number, Your fully completed claim form and receipts can be emailed to, Enrolment Card and Beneficiary Designation, Long Term Disability Attending Physicians Statement, Pension Enrolment and Beneficiary Designation Form, Travel Medical Emergency Assistance Wallet Card/Statement of Benefits. The Dental Plan will cover you and your eligible dependents. Your copayment is based on the type of drug prescribed: You can receive up to a 100-day supply of maintenance medication at one time from the mail order service prescription program. Global Excel can be contacted as follows: Ontario Ironworkers Pension & Benefit Plan. Local. (Dependents use the Member Login option to login to their account. 2nd Floor Injection of antibiotic drugs in connection with a covered dental procedure. %%EOF This web site provides details of Benefit Plans, but is not a legal document. Box 34203 Seattle, WA 98124-1203. Ironworkers Local 24. The Administrator provides these services for the participating locals in Windsor, Sarnia, London, Hamilton, Ottawa, Thunder Bay, Sudbury, Ste. ABOUT US. Every union contract is different, from local to local and company to company, but if you join the union, you can typically expect: Higher wages; Health insurance; Life insurance; A defined benefit pension and/or an annuity fundnot just a 401(k) New York, N.Y. 10036 Continue. Part 3 is for patient information whether that is yourself, your spouse, or one of your dependent children. To book an appointment with a representative, please click here. The Member, his spouse and their three children are all covered under both Plans. Present your pay-direct card to your dental office receptionist when you arrive for your appointment. Life insurance benefits are administered by Aetna Insurance Company. Member Paid Medical, Dental and RX Claims, may be submitted for direct reimbursement to: NW Ironworkers Health and Security Trust PO Box 34464 Seattle, WA 98124-1464. Inc. ), Iron Workers web site the Administrator of these Funds can be contacted as follows: Ontario Pension. 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