HEALTH & WELFARE

IMPORTANT NOTICES AND LINKS

Form 1095-B Information

This notice contains important information regarding the Form 1095-B and filing your personal income tax return. You do not need Form 1095-B to complete and file your personal income tax return and will no longer automatically receive Form 1095-B from the Fund.

View Notice

Disclosure Notice Regarding Patient Protections Against Surprise Billing

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn't be charged more than your plan's copayments, coinsurance and/or deductible.

View Notice

Transparency in Coverage Rule

This link leads to the machine readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.

MACHINE READABLE FILES

PLAN DOCUMENTS AND NOTICES

Summary Plan Description (SPD)

The SPD summarizes the key provisions of the Plan and includes important information about your benefits from the Plan.

Summary of Material Modifications (SMM)

The SPD is updated from time-to-time and includes additional information and changes to the Plan in the form of an SMM.

SMM - Hospitalization Prior Auth

The SPD is updated from time-to-time and includes additional information and changes to the Plan in the form of an SMM.

SMM - Out-Of-Network Vaccine Limit Removal

The SPD is updated from time-to-time and includes additional information and changes to the Plan in the form of an SMM.

Summary of Benefits and Coverage
- Plan 1

This document provides you with a quick reference to covered expenses, deductibles and out-of-pocket costs. This is not a full explanation of the benefits covered by the Plan. For more information about the benefits covered by the Plan, see the Summary Plan Description and Benefit Alerts.

Summary of Benefits and Coverage
- Plan 2

This document provides you with a quick reference to covered expenses, deductibles and out-of-pocket costs. This is not a full explanation of the benefits covered by the Plan. For more information about the benefits covered by the Plan, see the Summary Plan Description and Benefit Alerts.

Summary of Benefits and Coverage
- Retirees

This document provides you with a quick reference to covered expenses, deductibles and out-of-pocket costs. This is not a full explanation of the benefits covered by the Plan. For more information about the benefits covered by the Plan, see the Summary Plan Description and Benefit Alerts.

FORMS

Change of Address Form

Complete this form to change or correct your mailing address and return it to the Fund Office.

Change of Name Form

Complete this form to change or correct your name and return it to the Fund Office.

Information Verification Form

If you have a life-changing event and need to update dependent information, this form must be completed and sent to the Fund Office, with the appropriate documentation (birth certificate, marriage certificate, divorce decree, etc.). Make sure to include all dependents on the form or it will not be accepted.

Family Privacy Form

If you want the Plan to disclose your protected health information to another individual(s), persons, class of persons, or organization of your choice (for example, your spouse), you must fill out this form and return it to the Fund Office. If your spouse and/or Dependent child(ren) over the age of 17 (i.e. Dependent child(ren) who are at least 18 years old) want the Plan to disclose their protected health information to you or anyone else, they also must fill out this form and return it to the Fund Office.

Beneficiary Designation Form

To designate a beneficiary for your death benefit, you must fill out this form and return it to the Fund Office.

Member Reimbursement Claim Form

If your provider does not automatically submit your bill to the Fund Office, please complete this form and return it to the Fund Office with the appropriate itemized bills.

Initial Disability Claim Form

If you become disabled and are unable to work, you and your physician must complete this form and submit it to the Fund Office in order to receive the extension of Welfare benefits.

FREQUENTLY ASKED QUESTIONS

Complete a Change of Address Form. You may print and complete the form, or you may contact the Fund Office and a form will be mailed to you.
Complete a Name Change Form. You may print and complete the form, or you may contact the Fund Office and a form will be mailed to you.
Contact the Fund Office and ask to speak with an Accounts Receivable Specialist. They will verify eligibility and request a new Welfare ID card. Your new ID card will arrive within 7-10 business days from the date you notify the Fund Office that you need a new card.
Once you become eligible for benefits, you will receive your Welfare ID card within 7-10 business days.
The Service Providers area provides links to the Welfare service providers BlueCross BlueShield of Kansas City and CVS Caremark. Once you have selected the desired provider site, you may login to your account if applicable and search for in-network providers.
If you would like to view your Medical EOBs, please visit the BlueCross BlueShield of Kansas City website. Once you are on the BCBS website, you will need to login to your account to access your EOBs.
If you receive services from a non-participating provider and they are unable to submit the claim on your behalf, then you may have to submit the claim to the Plan. If you need to submit a claim, you will need to request an itemized bill from the provider then complete a Member Reimbursement Claim Form. Forward the itemized bill and completed form to the address as it appears on the claim form
Complete a Beneficiary Designation Form and mail to the Fund Office.
To enroll your spouse for coverage under the Plan, submit a completed Information Verification Form along with a copy of the marriage certificate to the Fund Office. Make sure to include all dependents on the form or it will not be accepted.

To enroll your dependent child for coverage under the Plan, submit a completed Information Verification Form along with a copy of the birth certificate or adoption papers to the Fund Office. If you are not married to your child’s birth mother/father, then you would also need to submit any divorce decrees and/or child support documents to the Fund Office.
Submit an Initial Disability Claim Form to the Fund Office. For additional update requests, you may complete the Supplemental Disability Claim Form. If you are disabled on Workers Compensation, you must submit Proof of Compensation and be unable to engage in any occupation or employment for wage or profit.
You can review the Summary Plan Description electronically or You can call the Fund Office to request a hardcopy of the SPD Booklet.
The Summary Plan Description is the document that details the benefits of the health plan. The SPD will provide information about the health plan such as the applicable co-pay amounts, deductible amounts, and out of pocket maximums.
To update your other insurance information, submit a completed Information Verification Form. You may complete the form, by clicking the link. Make sure to list all eligible dependents, whether they are covered under the other insurance or not, or it will not be accepted.
If your other coverage has terminated, we will need a copy of the Certificate of Creditable Coverage (COCC) sent to you by the other insurance company. You can mail the Certificate to the Fund Office.
You can review the Summary Plan Description electronically or You can call the Fund Office to request a hardcopy of the SPD Booklet.
You or your spouse must notify the Plan and mail a fully executed copy of your divorce decree to the Fund Office. Once the Plan receives the divorce decree, your former spouse’s coverage will be terminated as of the date of your divorce. You may also want to submit an updated Beneficiary Designation Form.
If you have any questions about your eligibility, benefits or claims, contact the Fund Office at (816) 777-2668 or (833) 479-9428. If you have any questions about Union membership or related matters, contact your Local Union.

SERVICE PROVIDERS

BlueCross BlueShield of Kansas City Logo.

Blue Cross Blue Shield of Kansas City

Visit Blue Cross/Blue Shield of KC to:

  • Find a network provider
  • Access Member Center to view your claims and EOBs (Explanation of Benefits)
  • Find health and wellness information
  • Use Telehealth BlueKC Virtual Care Program
CVS Caremark Logo.

CVS Caremark

CVS Caremark provides access to a retail pharmacy network, mail order prescriptions and specialty pharmacy prescriptions.

  • Refill prescriptions
  • Find network pharmacies
  • Search for medications

(816) 756-3313     (866) 756-3313

Street Address:
12200 N Ambassador Drive, Suite 400    Kansas City, MO 64163


Mailing Address:
PO Box 909500    Kansas City, MO 64190-9500