Teamsters Joint Council No. 83 of Virginia

Health & Welfare and Pension Funds

Frequently Asked Questions

Listed below are frequently asked questions regarding the Health & Welfare Fund. Click on the question to view the answer.

Admission Notification

If I am admitted to the hospital, is admission notification required?

Effective July 1, 2015 pre-certification by Hines & Associates, Inc. is required for inpatient admissions. Contact Hines & Associates, Inc. at 1-888-852-8382. Failure to pre-certify will result in a $500 penalty to the Fund's payment. No payment will be made for any services not authorized by Hines & Associates, Inc. For more information regarding pre-certification, click here.

Dental Benefits

How should a dental claim be filed?

We do not accept electronic dental claims. Dental claims must be mailed or faxed to the Fund Office. For contact information, click here.

How do I find a dentist that participates in the Anthem National Dental PPO?

To find a participating dental provider in your area, follow these steps:

  1. Log onto www.anthem.com. From the "Find a Doctor" tool, follow these steps:
  2. Select "Dental" under "What are you looking for?"
  3. Select "Dental plan dentists" under "Type of Visit".
  4. Enter your search options (i.e. name, type of dentist, etc) under "About the Provider";.
  5. Enter your zip code or city and state under "Where are you looking";.
  6. Select your state under "What insurance plan would you like to use";. Use the dropdown menu to select "Dental Plans"; as the "Plan Type"; and "National Account Dental"; as the Plan Name, then click "search".

What if there are no dentists in my area that participate in the network?

You will not be penalized for seeing a dentist outside the network. However, by visiting a dentist in the network, your charges will be discounted, leaving you with no liability, provided you are eligible for benefits and have not met your family maximum.

Disability Benefits

Does the Fund offer Short Term Disability?

The Fund does offer Short Term Disability to eligible participants. For more information, click here. Be sure to consult your Schedule of Benefits for specific benefit information.

Does the Fund offer Long Term Disability?

The Fund does not offer Long Term Disability.

How often does the Fund mail disability payments?

Provided that all necessary information is received on Wednesday by 4:30PM, your disability payment will be mailed out on Thursday of every week.

My doctor is charging to fill out the disability form. Do I have any other options to have the form completed without a charge?

Most doctor offices have their own forms for disability and will fill them out free of charge. We do accept the doctor's form in place of our form, as long as it contains all the necessary information.

Eligibility

How can eligibility be verified?

You must contact the Fund Office for verification of eligibility. For contact information, please click here.

How do I add dependents to the Plan?

You may add dependents by submitting a Dependent form by email, by mail to 8814 Fargo Road, Suite 200 Richmond, VA 23229 or by fax at 804-288-3530. Changes cannot be made by telephone.

How can I remove my ex-spouse from the Plan?

You may remove your ex-spouse from the Plan by submitting a copy of your finalized divorce decree by email, by mail to 8814 Fargo Road, Suite 200 Richmond VA 23229 or by fax at 804-288-3530.

How can I verify benefits or inquire about claim status?

You must contact the Fund Office for verification of eligibility and claim status.

General

Who do I notify of a change in address?

You may submit a Change of Address form by email, by mail to 8814 Fargo Road, Suite 200 Richmond, VA 23229 or by fax at 804-288-3530. Changes cannot be made by telephone.

How can I change my life insurance beneficiary?

You may change your life insurance beneficiary by submitting the Change of Beneficiary form by email, by mail to 8814 Fargo Road, Suite 200 Richmond, VA 23229 or by fax at 804-288-3530. Changes cannot be made by telephone.

What rights do I have if I disagree with the Fund's payment or nonpayment of my claim?

If you disagree with the Fund's decision, you may ask to have it reviewed. Your written request for review must be received by the Fund Office within 180 days from the date you receive an "Adverse Benefit Determination" or denial notice. For more information on how to file an appeal, consult the Plan Document or contact the Fund Office.

I received an Explanation of Benefits (EOB) for a claim that I believe was filed incorrectly. What should I do?

You may contact the Fund Office to speak with a Claims Coordinator.

Does the Fund provide bereavement pay?

No. Contact your employer's Human Resources department for information regarding bereavement.

Maternity Management

Does the Fund offer a Maternity Management Program

For deliveries on or after July 1, 2015, no Maternity Management Program is required or available.

Medical Benefits

How should medical claims be filed?

All medical claims, both in and out-of-network, must be filed through the local BlueCross BlueShield (BCBS) plan. If you are unsure of the billing address, please contact the Fund Office.

How do I find a doctor/hospital that participates in the Anthem BlueCross BlueShield network?

To find a participating provider, you may call Anthem BlueCross BlueShield at 800-810-2583 and choose option 2, then option 1 on the automated system. You may also visit their website at www.bcbs.com and follow the steps below.

  • On the right hand side of the page, click on “Find a Doctor or Hospital” under “Useful Tools”.
  • You will see two different search options. Use the search option one the right that says “search using your plan”. You do not need to create a username and password. You can simply click on the link below that says “Use the alpha prefix (first three letters) of your member identification number to search without logging in”.
  • Enter the alpha prefix of “TJA” from your medical identification card.
  • Enter your zip code in step 3 and mileage radius in which you are searching.
  • On the following screen, you can search by specialty, location or provider name. Click “search”.

How do I determine if my doctor uses an out-of-network lab?

If you have lab work that is sent to an independent lab, ask your doctor if the lab participates in the BlueCross BlueShield PPO network.

Are all services covered by all Plans?

No, not all services are covered by all Plans. Consult your Schedule of Benefits for specific benefit information.

Prescription Coverage

Which card do I use for prescriptions?

Your prescription card should say Optum Rx on the front of it. To request a new card, please click here. Be sure to include your name, Unique Identification Number (UID) or Social Secruity Number and current address in the email. Please be aware that unencrypted, unauthenticated internet e-mail is inherently insecure. Email messages may be corrupted, incomplete, or may incorrectly identify the sender. To secure your message, try using a free secure email such as Safe-email.net.

How can I receive my prescriptions through the mail?

To receive your prescriptions through the mail, contact the Optum Rx Mail Order Pharmacy at 800-562-6223, or complete the Optum Rx Mail Order Form and mail it to Optum Rx at P.O. Box 509075, San Diego, CA 92150-9075. Be sure to include your original prescription with the form. You may also find the information on their website at www.optumrx.com.

Vision Benefits

How are vision claims filed?

If the provider participates in the EyeMed network, claims must be filed with EyeMed. If the provider does not participate with EyeMed, claims must be mailed, faxed or emailed to the Fund Office. For contact information, click here.

Does the Retiree Health Coverage Plan cover vision benefits?

No. There is however a discount for retirees covered through the Fund. If you have not received your discount card, please contact the Fund Office.