Welfare Plan FAQs

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  1. I am confused about how my benefits are coordinated with Medicare.

    Coordination Where Benefits are "Primary." When Medicare benefits are primary to any benefits under the Plan, Medicare benefits are paid first, and the payment of Plan benefits, if any, occurs second based on what Medicare has paid and other rules. For example, Medicare is primary to Plan benefits if you are eligible for Medicare based on age or disability and your coverage under the Plan is not based on current employment (as in the case of coverage for Retired Participants and their Dependents and certain "COBRA" coverage). In cases where Medicare coverage is primary, the Plan coordinates benefits with Medicare on a "carve-out" basis.

    Covered Expenses must first be submitted to Medicare. When you receive the "Explanation of Medicare Benefits" (EOMB) statement which shows how much Medicare paid, submit a copy of the Covered Expenses together with a copy of the Medicare EOMB statement to the Plan.

    First, the Plan will calculate what our "normal benefit payable" would be in the absence of Medicare coverage. Then, from our "normal benefit payable," we will deduct the benefit paid by Medicare and then also deduct the annual out of pocket deductible and out of pocket limits that apply under this Plan. The out of pocket limit will not be charged against inpatient hospital stays. For an inpatient hospital stay, once your $200 deductible is met under the Plan, the Plan will then pay 80% of the Medicare inpatient deductible. The Plan will pay only the difference between our "normal benefit payable" and the benefit paid by Medicare.

    It is important to remember that the Plan will not pay more than our "normal benefit payable," which is the amount the Plan would have paid in the absence of Medicare coverage. If the Plan's "normal benefit payable" and the benefit paid by Medicare are the same amounts, or if the benefit paid by Medicare is more than the Plan's "normal benefit payable," the Plan will not pay any additional benefits. The combination of the Plan's "normal benefit payable" and the benefit paid by Medicare will never exceed what the Plan would have paid in the absence of Medicare coverage.

    Please refer to the Summary Plan Description for further details.

    Coordination Where Medicare Benefits are "Secondary." Medicare benefits are sometimes "secondary" to those under the Plan, meaning that Plan benefits are paid first and Medicare benefits, if any, are paid second.

    Further Discussion of Coordination of Plan Benefits with Medicare. For an explanation of the rules on coordination of Plan benefits with Medicare go to the "Retiree Rules" BenefitTab.

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  2. What is the name of our insurance company?

    Your benefit coverage is provided through the Alaska Teamster-Employer Welfare Trust, which is a multi-employer employee benefit plan governed by a federal law called ERISA, the Employee Retirement Income Security Act.

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  3. Will the Plan cover 100% of all my bills?

    The Board of Trustees has designed a comprehensive program of Health Plan benefits for you and your eligible dependents. However, not all services you receive are covered by the Plan. For covered services, you will be responsible for deductibles, co-payments and co-insurance amounts. You may also be responsible for amounts above the Plan's allowance. If your doctor performs services that the Plan does not cover or if you receive treatment from a health care provider not recognized under the terms of the plan, you are responsible for the entire bill. It is not the intent of the Health Plan to dictate what type of treatment is appropriate for a patient, nor do we wish to imply that a specific treatment is not beneficial to your condition, but rather that, benefits can only be extended within the provisions and limitations of the Plan.

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  4. Will the Plan cover my dependents automatically or must I pay for that coverage?

    Once you meet the eligibility requirement, the Health Plan will cover your qualified dependents at no charge to you. Coverage will begin once you enroll all your eligible dependents.

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