Frequently Asked Medical Questions

1. Q. Is the Group Reimbursement Welfare Plan a primary medical insurance plan?

A. It is a tertiary Plan and payer of last resort. This means that if you have any other source of payment, this Plan will pay the difference, if any, between the maximum amount payable from the other coverage source and the amount of the healthcare service provider’s bill up to the maximum amount of benefits as described in your Group Reimbursement Welfare Plan booklet.

For example, if your spouse works and is covered at his or her employment by any benefit plan, reimbursement, or insurance that would also cover you, then you must first seek payment for your claims from that source. That is what having another source of payment for benefits means. Other sources of benefits include a lawsuit against the person or party who injured you as well as governmental programs. You are first required to make an application for benefits or payment under any such plan or source other than this Plan, including a situation where potential litigation may result in recovery. This does not pertain to payments made by Medicare or Medicaid.

2. Q. How do I obtain my Group Reimbursement Welfare Plan booklet?

A. See your Shop Steward and ask him/her to obtain a copy for you from your Local 464A Union Agent or Service Representative.

3. Q. I have not received my Horizon Blue Cross/Blue Shield medical card, why?

A. To receive your Horizon Blue Cross/Blue Shield medical card you must enroll in the health care program by completing the Welfare Funds of Local 464A Healthcare Coverage Enrollment Form and Subrogation Form. These forms are sent to each employee with his or her UFCW Local 464A membership card when he/she is hired or re-hired. If you have not filed your forms with Local 464A click Forms for copies that you can print or call 973.256.5803 to have the forms sent to you. There is generally a 6 or 9-month waiting period before benefits go into effect. Your Horizon BC/BS medical card will not be received until your benefits become effective.

4. Q. What should I do if I lose or damage my Horizon Blue Cross/Blue Shield medical card?

A. Contact the Benefits Department at 973.256.5803 for a replacement card.

5. Q. Who do I call if I have a question about my medical benefits?

A. Consult your Group Reimbursement Welfare Plan booklet. If you still have a question call Maxon at 1.800.999.3309. This is the Member Service telephone number on your Horizon Blue Cross Blue Shield medical card.

6. Q. What if I have a question about a medical bill?

A. Call Maxon at 1.800.999.3309. This is the Member Service telephone number on your Horizon Blue Cross Blue Shield medical card.

7. Q. I have received a medical benefit denial and I need an explanation; where do I call?

A. Call Maxon at 1.800.999.3309. This is the Member Service telephone number on your Horizon Blue Cross Blue Shield medical card.

8. Q. How can I find the UFCW Local 464A participating medical care center closest to me?

A. See your Group Reimbursement Welfare Plan booklet or click here.

9. Q. I am a part-time employee; can I add my dependents to my medical coverage?

A. You must be a full-time employee to include your eligible dependents under the Plan.

10. Q. I have my own medical provider who is not associated with any of the UFCW Local 464A participating medical centers. Is this permitted?

A. Yes, you can use any covered medical provider you wish. For a list of providers who are part of the Horizon Blue Cross/Blue Shield in-network group of physicians call toll-free 800.810.2583 or go to www.horizonblue.com.

11. Q. But what if I prefer a medical provider who is not in-network?

A. If you use a covered medical provider who is out of network your claims will be processed according to the Plan’s Schedule of Allowances and may be subject to a yearly deduction. Be sure to fully understand the medical coverage applicable to you by reading your Group Reimbursement Welfare Plan booklet. If you have questions contact Maxon at 1.800.999.3309. Always be sure to present your medical card to your provider whether in-network or out of network.

12. Q. What is COBRA?

A. COBRA stands for the Consolidated Omnibus Budget Reconciliation Act of 1985. It is a federal law that allows for the continuation of healthcare plan coverage that would otherwise end because of a “qualifying event”. See your Group Reimbursement Welfare Plan booklet for details.

13. Q. What is a “Qualifying Event”?

A. A “qualifying event” is either one of the following occurrences: 1. Your hours of employment are reduced, or 2. Your employment ends for any reason other than your gross misconduct.

14. Q. Who pays for COBRA continuation coverage?

A. Generally, you are required to pay the entire cost of the continuation of coverage. The amount you may be required to pay may not exceed 102% (or, in the case of an extension of continuation coverage due to a disability as determined in writing by the Social Security Administration, 150%) of the cost to the group health plan for coverage of similarly situated plan participants or beneficiaries who are not receiving continuation coverage.

15. Q. I have had a “qualifying event” how do I apply for COBRA continuation coverage and how can I find out how much it will cost?

A. Contact the Plan Administrator at the Little Falls, NJ offices, 973.256.5803.

16. Q. How long will my COBRA continuation coverage last?

A. In the case of loss of coverage due to the end of employment or reduction in hours of employment, COBRA coverage generally may be continued for up to a total of 18 months from your last physical day worked. An additional 11-month extension may be available if you are determined by the Social Security Administration (SSA) to be disabled. See your Group Reimbursement Welfare Plan booklet for details.