Health Fund Eligiblity: Equity-League Fund

We are getting medical and dental plan opportunities in synch and on the same schedule this year. The Open Enrollment application period under the Equity-League Health Trust Fund (for both medical and dental benefits) will now be held during the month of November of each year, with an effective date of coverage the first day of the following year – January 1. Therefore, you will have the opportunity to change your medical plan option and make your dental election at the same time. The effective date of the “change in health and/or dental coverage” will be January 1, of each year. The application deadline will be no later than November 30.

Why synch enrollment opportunities? It’s more convenient for participants. This way medical and/or dental election can be done at once. A single enrollment period also eliminates the issue that arose when members only had six months to reach the $350 individual/$700 family out-of-network medical deductible, the $5,000 individual/$10,000 family out-of-pocket maximum, and the $100 individual/$200 family annual pharmacy deductible – all which are intended to be annual under the CIGNA Open Access Medical (the “OAP”) and Pharmacy Plans administered by CIGNA.

Medical Benefits

Participants will have the option to either enroll in a HMO, or transfer to the CIGNA OAP plan. Cigna and HMO Summary of Benefits material can be located under the SUMMARY OF BENEFITS area, located on the main Health Fund page.

Dental Benefits

Participants, covered by employment for health benefits, will also have the opportunity to purchase self-pay dental coverage administered through CIGNA or transfer to the alternate plan depending on what you currently already have. There are two plans to choose from; a Dental HMO (DHMO) Plan, or a CIGNA Dental Core PPO Plan. If you purchase voluntary dental coverage, you can also extend it to your eligible dependents as well (see below for an explanation of dependent coverage). Dental enrollment material is also available under the CIGNA Self-Pay Dental Information link, located on the main Health Fund page. A dental packet can also be mailed to you upon request.

Dependent Coverage

You are add a child, spouse, or domestic partner under the CIGNA OAP plan (obtain domestic partner affidavits from the Fund Office, or download a copy under the section of the CIGNA or HMO Summary of Benefits area) as a dependent(s) to your coverage as well. The appropriate dependent forms and selfpay rates for adding dependent coverage are located under the CIGNA SUMMARY OF BENEFITS area.

When adding a child, spouse, or domestic partner to an HMO plan as a dependent to your coverage, please contact the HMO Coordinator at the Fund Office for any enrollment change form applicable to adding a dependant to your HMO plan as well as for the current dependent rate. Applications and dependent rates for all of the HMO plans can also be located under the SUMMARY OF HMO BENEFITS area under the Health section tab from home page.

In order to enroll a dependent under any coverage type, you MUST provide proof of dependent status – for example, a marriage certificate, birth certificate, certification of student status, proof of residence and/or proof of financial dependency.

Once all of the appropriate form(s) have been completed, along with your premium payment, they are to be sent to the Fund Office for processing. Your application for dependent coverage cannot be processed without a completed form and premium payment.

You may also pay your premium by check or credit card. If you elect the credit card payment option, go the home page, and click on the link, “Health Care Payments”. PLEASE NOTE THAT CREDIT CARD PAYMENTS ARE NONRECURRING. The Health Fund will not automatically charge your credit card every time a payment is due. You will have to initiate a new transaction each time you elect to make your payment by credit card.

CHANGES TO THE CIGNA DENTAL PLANS

CIGNA Dental PPO Plan (DPPO)

For those that already have dental coverage, there is no change in coverage, but CIGNA has changed the name of this plan’s network to CIGNA DENTAL CORE. By using dentists in the Core Network, participants will spend less because CIGNA Dental has negotiated special rates with these dentists, approximately 35% off the average area charges. Of course, you can still utilize the out-of-network benefit under this plan if your dentists are still not participating under the CORE network. The same benefits still apply. To search for a dentist under the Dental Core Network, please go to CIGNA’s online provider directory, www.cigna.com and follow these steps:

Click “Provider Directory” at the top of the page.

Click “Dentist”. Enter your search criteria – location, name, etc.

Next, select the CIGNA Dental PPO and in the drop down box, select “CORE NETWORK”.

CIGNA DENTAL HMO PLAN (DHMO)

For those that already have dental coverage under the CIGNA Dental HMO Plan (DHMO), there will be no increase in your quarterly billing costs. This plan is still cheaper than the DPPO plan, and covers the same services as the DPPO as long as they are listed on the plan’s fee schedule. Under this plan, there is a benefit fee schedule, which lists your out-of-pocket costs associated with the procedures you have done. For the most up to date schedule, please visit the CIGNA Self-Pay Dental link located under the Health section. Upon request, a fee schedule can also be mailed to you. To search for a dentist under the CIGNA DHMO Plan, just follow the same steps listed above under the DPPO Plan, and select the CIGNA Dental Care (HMO) option instead to search for providers.

You can also contact CIGNA directly, 1-800-CIGNA24, and speak to a customer service representative for assistance in locating a dentist under either network.

Should you have any questions, please do not hesitate to contact the Health Department within the Fund Office at (212) 869-9380, or toll free at (800) 344-5220. As a reminder, the walk-in office hours are Monday through Friday, 9:30 AM to 5:30 PM Eastern Time, and our telephone hours are 9:30 AM to 8:00 PM Eastern Time.